Newport Address:
51 High Street
Newport, Shropshire
TF10 7AT
01952 812 380

Stafford Address:
Odeon Buildings,
1 Newport Road,
Stafford, ST16 2HH.
01785 251 790

E-mail: click here

Shop, office and Property Owners Quotation form

Proposer Details

Title: >> select >> Mr >> Mrs >> Miss >> Ms >> Dr.

First Name:

Surname:

Company Name:

Company Status: >> select >> Limited >> Sole Trader >> Partnership

Correspondence Address:

Postcode:

Risk Address (if different):

Contact Telephone number:

Contact Email Address:

Business Description:

Trading from date:

Time at this address:

Experience in Trade:

Cover Details

Buildings cover required: >> select >> yes >> no

Building Construction date:

Sum Insured:

Contents Cover Policy will automatically provide Employers Liability of £10 million and Public Liability of £2 million

Landlord fixtures/fittings:

Tenant Improvements:

All Other Contents:

Computer Equipment:

Shop Front:

Stock:

Wines:

Beers:

Spirits:

Cigarettes:

Frozen Food:

Business Interruption:

Goods in Transit:

Any Other (provide details):

Security Details

Details of Burgular Alarm System:

Details of CCTV:

Details of other physical security:

Existing Arrangements/History

Present Insurers:

Renewal Date:

Renewal Premium Offered:

Claim Details:

Date:

Description of loss:

Amount paid:

 

© Fiveways Insurance Consultants Ltd