Innsure Insurance Quotation Form |
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| Contact Name:* |  |
| Business Name:* | |
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| Address line 1:* | |
| Address line 2:* | |
| Town or city:* | |
| Postcode:* | |
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| Daytime Contact Number:* | |
| Mobile Number: | |
| Email Address: | |
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Business Information |
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| Renewal Date: | |
| Current Insurer + Broker: | |
| Annual Premium: £ | |
| Type of Business: | |
| No. of letting bedrooms: | |
| Owner lives on premises: | |
| How many years in business:* | |
| Alarm: | |
| If yes: | |
| Any form of entertainment: | |
| If yes, type: | |
| Childrens' Play Area: | |
| Deep Fat Frying: | |
| Admission Charge: | |
| Doorstaff: | |
| Construction of Walls: | |
| If Other please specify: | |
| Construction of Roof: | |
| If Other please specify: | |
| Any area of felt on timber flat roof?: | |
| If Yes, please specify the percentage of roof area: | |
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| Claims in the last 5 years? Number: | |
| Claims in the last 5 years? Cost: | |
| Claims in the last 5 years? Type: | |
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Cover and Sums Insured |
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| Accidental Damage Cover: | |
| Subsidence Cover: | |
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Core Cover (compulsory) |
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| Buildings: £ | |
| Tenants Improvements: £ | |
| Contents: £ | |
Stock: |
| Wines and Spirits: £ | |
| Tobacco: £ | |
| All other stock: £ | |
| Frozen Food: £ | |
| Business Interruption: £250,000 over 12 months. Is this adequate? If not, please state amount: | |
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| Months indemnity period: | |
Public Liability / Products Liability - £2,000,000 |
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Employers Liability - £10,000,000 |
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Money - During Business Hours: |
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In Transit - £3,000 |
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In Safe - £1,500 |
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Optional Covers |
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| Book Debts (£10,000) Required?: | |
| Loss of license (£100,000) | |
| Personal Contents | |
| Please state sum: | |
| Personal Possessions (worldwide): | |
| Please state sum: | |
| Legal Expenses (£50,000) | |
Personal Accident: |
| £10,000 death | |
| £100 p/w temp total disablement | |
| £50 p/w temp partial disablement | |
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| Goods in Transit (£2,500) | |
| Employee Dishonesty (£10,000) | |
| Directors and Officers (£250,000) | |
