Email* Enter your email address to receive a copy of this submission.Select the cover you are interested inCover you are Interested in?* Select All Fire & other specified perils Business Interruption Burglary Money Glass Liability Transit Electronic Computer Breakdown Machinery Breakdown General Property Tax Audit Employee Fraud Motor Vehicles Thank you for your interest, now tell us who this enquiry is forFor us to provide the best response to your inquiry please complete the following* This inquiry is for an existing business with current insurance This inquiry is for an existing business without insurance This inquiry is for a new business Let's get started with your personal informationName* First Last Email address* Telephone*Address* Street Address City State Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Tell us about your BusinessName of the business*Describe your businessWhat is the required start date of the insurance? DD slash MM slash YYYY Is your business premise address different to your contact address?* Yes No Business Address* Street Address Does your business operate from multiple sites?* Yes No Can you give more information about the building where your business is operatedAge of building in yearsWhat is the roof made of?* Tile Steel What are the walls made of?* Brickwork Concrete Steel on steel Steel on wood What are the floors made of? Timber Concrete What type of alarm system is installed?* Monitored Local None Tell about Fire & other specified perilsSum Insured Building $Stock $Contents $Others (please specify}Description$ Business InterruptionIndemnity Period 6 months 12 months Sum Insured Gross ProfitIncreased Working CostWagesRentOtherOther DescriptionTotalBurglarySum Insured ContentsStockTobaccoCombined contents / stockOtherOther DescriptionMoneySum Insured In TransitOn PremisesOn premises outsideBusiness hoursIn SafePersonal custodyOther $Other DescriptionGlassSum Insured Internal or External Internal - Replacement Value External - Replacement Value SignsLiabilitySum Insured Payout $5 Million $10 Million $20 Million TurnoverWages PaidStaff NumbersAre you the property owner? Yes No Describe tenant's businessDo you import products? Yes No Product DetailsProduct nameCountry of origin TransitOwn VehiclesMaximum Value per loadAnnualised Total CarryNumber of Vehicles #Professional CarriersMaximum Value per loadAnnualised Total CarryElectronic Computer BreakdownDescribe equipment you wish to insureSum InsuredMachinery BreakdownSum Insured RefrigeratorAmount of unitsUnits $Air ConditionerAmount of unitsUnits $OtherAmount of unitsUnits $General PropertyDescribe equipment you wish to insure 'away from your business' (e.g. laptop computers)Sum InsuredTax AuditSum InsuredEmployee FraudSum InsuredMotor VehiclesMake and modelYearRegistration NumberMain DriverDate Of Birth DD slash MM slash YYYY The vehicle is garaged No Yes Garage postcodeNCB rating or rating numberUse Business Private Under Finance No Yes Prior to the Insurer accepting any risk they will require information about any claims over the past 5 years where the claims relate to the type of insurances you wish to take out. Please describe those claims:How would you prefer us to contact you?* Phone Email This field is hidden when viewing the formEmail A Copy To MeEmail A Copy To Me Tick for yes CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
