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Office Insurance Quotation
To help us provide you with out best possible quotation, please complete as much of the following quotation form as you can.
Title
Mr
Mrs
Miss
Ms
Dr
Name
Trading Name
Address
Address 2
Address 3
Address 4
Postcode
Telephone
Email
Occupation/Trade
Years Trading
Claims/Losses in the last five years
Age of Building
Is the property a listed building
Not listed
Grade 1
Grade 2
Grade 3
Construction of walls
Brick
Stone
Block
Steel
Timber
Type of roof
Slate
Tile
Concrete
Bitumen
Felt on Timber
Other
If flat roof:
Percentage of flat roof on property
%
Type of flat roof
Please Select
Concrete
Bitumen
Felt on Timber
Other
Please advise security as follows
Do you have 5 lever deadlocks on all final exit doors
Select
Yes
No
If No then please advise the types of lock:-
Do you have window locks on all opening accessible windows
Select
Yes
No
Shutters
None
On Shop Front Only
On All Windows And Doors
Type of Alarm
None
Bells Only
Digital Comunicator
Redcare
Is the alarm on an annual maintenance contract
Select
Yes
No
CCTV
None
Internal
External
Both Internal & External
Do you live on the premises
Select
Yes
No
Do you do any repairs of maintenance to customers goods
Select
Yes
No
Do you work away from your premises (other than collection & delivery)
Select
Yes
No
If yes details of work away carried out
Sums Insured
Buildings
Tenants Improvements
Loss of Rent
Fixtures & Fittings
Computer Equipment
Electronic Equipment
Business Interuption
Money
Glass - Full Reinstatement
Public Liability
amend if higher limit required
Product Liability
amend if higher limit required
Employers Liability £10,000,000
In order to calculate the premiums for the Liability sections we will require the following information
Projected Approximate Annual Turnover
Projected Approximate Annual Wages Roll
Ever been declared bankrupt or insolvent?
Please Select
Yes
No
Been convicted of any criminal offence, which is not 'Spent'?
Please Select
Yes
No
Had any County Court Judgements entered in the last six years?
Please Select
Yes
No
WestPennine Insurance Services Group is the trading name of WestPennine Insurance Consultants Limited. Registered Office 84 Church Street, Littleborough. OL15 8AU. Registered in England number 939318
Telephone 01706 378990 Fax 01706 371417
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