General
Incorrect answers or failure to disclose all material facts may render the insurance inoperative. Material facts are those which would influence acceptance or assessment of the insurance risk. If you are in doubt, please disclose them or seek assistance from our insurance representative.
Name of Proposer(s)
Address of Premises to be Insured
Postcode
Tel No
Fax No
Email Address
Section 1 - Buildings
Required
Yes No
Total Reinstatement Value (Including All Outbuildings and Swimming Pools)
£
Section 2 - Contents
Required
Yes No
Leaseholders interior decorations
£
Liquor
£
Cigarettes
£
Beer and Other Consumables
£
Total Reinstatement value (Exclude Personal Property if included under Section 11)
£
Section 3 - Rent
(A) Rent payable 12 months indemnity period
Yes No
£
(B) Rent receivable 12 months indemnity period
Yes No
£
Section 4 - Revenue - Including Auditors Fees
Indemnity period - 12 months
Yes No
£
Section 5 - Book Debts
Required
Yes No
£
Registered in England: Number 608819
Authorised and Regulated by the Financial Services Authority
Registered Office:
Lygon House, 50 London Road, Bromley, Kent. BR1 3RA