Personal Details
Name
Correspondence
Address
Post Code
Telephone
Email address
Property Details
Premises Address
Premises Post
Code
Occupants Trade
(list if
multiple)
Sums Insured
Buildings
Day 1 inflation
protection
0%
15%
30%
50%
over
12 Months
24
Months
36
Months
Annual rent sum
insured
Rent period of
indemnity
12 Months
24
Months
36
Months
Property owners
liability
£1,000,000
£2,000,000
£5,000,000
Not
Required
Landlords
fixtures &
fittings
Options
Perils
All risks
Fire,
Perils and
Subsidence
Fire and
full perils
Fire,
Lightning,
Aircraft &
Explosion
Terrorism cover
Legionellosis
extension
Employers
liability
Employers
liability
details
(list
occupations and
wage roll)
Construction
Details
Year built
(approximate)
Construction
walls
Brick
Stone
Concrete
block
Composite panels
Composite panels
(mineral wool)
Part
Brick/ Concrete/
Steel
Timber
Construction
roof
Tile
Slate
Corrugated
Concrete/
Asbestos
Steel
Timber
Thatch
Flat
felt
Flat
concrete
Pitched
felt
Proportion flat
felt roof (%)
Number of
storeys
Discount
features
Do you have an
annual
electrical
wiring
inspection?
Year?
Smoke alarms
installed?
Fire
extinguishers
installed?
Sprinkler system
installed?
Security
features: (list
any features
such as security
guards,
concierge,
locked compound,
CCTV etc)
Past experience
Number of years
owned
Current insurers
Current premium
Renewal/
deadline date
Claims in last 5
years - provide
circumstances,
date and amount
(if none -
state)
Additional
information
Please list any
other
information
which may
influence the
underwriters
quotation