| Address Line 1: |
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Town/City: |
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| Address Line 2: |
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Region/County: |
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Postcode: |
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| How long have you been established? |
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Buildings Sum Insured (if required) |
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| Date of Renewal dd/mm/yyyy |
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| Is the property standard construction
(brick/slate/stone/tile) |
Yes No |
| Trade Type |
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| Contents/Fixtures & Fittings Sum |
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| Cost of Office Computer Equipment: |
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| Alarm Type |
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Grills or Shutters |
Yes No |
| Any Local Authority CCTV |
Yes No |
Do you live on the premises? |
Yes No |
| Have you had any property insurance claims or losses in the
last 3 years? |
Yes
No |
| Dates & Details of Claims within the last three
years including amount and type. |
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| Any further details which you feel may affect
your application? |
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