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Shop Insurance Form
Acceptability Criteria
The property to be insured:
• is in good repair and will be so maintained.
• is of Standard Construction (constructed of brick, stone or concrete and roofed with slates, tiles, asphalt, metal or concrete)
• must
NOT
have been previously flooded, be located in an area which has previously flooded or be particularly exposed to flood damage
• must
NEVER
have shown signs of subsidence, heave or landslip, coastal or river erosion or be located in an area exposed to such damage.
The proposer or any director, partner or Princial of the business:
• must
NEVER
have been convicted of or charged with (but not yet tried for) any criminal offence, (other than a motoring offence)
• must
NEVER
have been refused insurance, had special terms or conditions imposed, or had insurance cancelled or renewal refused
• must
NOT
, in the past 5 years, have incurred any claims or suffered any losses for any of the perils or contingencies to which this insurance applies.
I Agree:
*
Yes
No
Contact Details
Title:
*
Please select
Mr
Mrs
Miss
Ms
Name:
*
First
Last
Phone Number:
*
Email Address:
*
Postal Address:
*
Second Line Of Address:
Town/City
*
County:
Post Code:
*
Business Details
Business Name:
*
Business Description:
*
Address (if different from the contact address):
How Long Have You Occupied These Premises?
Building description:
1 Does any part of the property have a flat roof?
2 Are the walls built of brick, stone or concrete and the roof of slate, tile or concrete? If
No
please give details below.
1. Does any part of the property have a flat roof?
*
Please select
0%
Up To 25%
Up To 50%
Up To 75%
Over 75%
2. Are the walls built of brick, stone or concrete and the roof of slate, tile or concrete?
*
Yes
No
2. Please Give Details Of Non-Standard Construction:
Does anyone live on the premises?
*
Yes
No
Security at your premises.
Door Locks 5 Lever Mortice Lever:
*
Yes
No
Are all external doors and if applicable, internal doors leading to common parts fitted with 5 lever mortice deadlocks?
Window Locks:
*
Yes
No
Are all ground floor windows and any other accessible windows protected by either grills or roller shutters or internal bars?
If you have answered NO to either of the last two questions, please provide full details of the security applicable?
Are the premises covered by their own CCTV?
*
Yes
No
Please give detais
If YES give details of Area covered and how long they are recorded for?
Intruder Alarm:
*
Yes
No
Is work done away from premises?
*
Yes
No
Cover Required
Renewal / start date:
*
DD
/
MM
/
YYYY
Buildings Sum Insured:
*
£
Pounds
Buildings (incl. landlords fixtures & fittings & Tenants improvements)
Contents Sum Insured:
*
£
Pounds
Stock in trade:
*
£
Pounds
How May We Contact You?
Prefered Contact Method:
*
Please select
Phone
Email
Preferred Contact Date & Time:
*
DD
/
MM
/
YYYY
HH
:
MM
AM
PM
AM/PM
