Cover you are Interested in?* Fire & other specified perils Business Interruption Burglary Money Glass Liability Transit Electronic Computer Breakdown Machinery Breakdown General Property Tax Audit Employee Fraud Motor Vehicles Domestic/Residential Thank you for your interest, now tell us who this enquiry is for?For 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 information?Name* First Last Email* Telephone* Address* Street Address City State Postcode Country 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 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 City State Postcode Does your business operate from multiple sites?* Yes No Can you give more information about the building where your business is operated?Age of building in years What 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 Profit $ Increased Working Cost $ Wages $ Rent $ Other $ Other Description Total $ BurglarySum Insured Contents $ Stock $ Tobacco $ Combined contents / stock $ Other $ Other Description MoneySum Insured In Transit $ On Premises $ On premises outside $ Business hours $ In Safe $ Personal custody $ Other $ Other Description GlassSum Insured Internal or External Internal - Replacement Value External - Replacement Value Signs $ LiabilitySum Insured Payout $5 Million $10 Million $20 Million Turnover $ Wages Paid $ Staff Numbers $ Are you the property owner? No Yes Describe tenant's business Do you import products? No Yes Product 1 Country of origin 1 Product 2 Country of origin 2 Product 3 Country of origin 3 TransitOwn VehiclesMaximum Value per load $ Annualised Total Carry $ Number of Vehicles # Professional CarriersMaximum Value per load $ Annualised Total Carry $ Electronic Computer BreakdownDescribe equipment you wish to insureSum Insured $ Machinery BreakdownSum Insured RefrigeratorAmount of units Units $ Air ConditionerAmount of units Units $ Other Amount of units Units $ General PropertyDescribe equipment you wish to insure 'away from your business' (e.g. laptop computers)Sum Insured Tax AuditSum Insured $ Employee FraudSum Insured $ Motor VehiclesMake and model Year Registration Number Main Driver Date Of Birth DD slash MM slash YYYY The vehicle is garaged No Yes Garage postcode NCB rating or rating number Use 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 Email A Copy To Me Tick for yes CAPTCHANameThis field is for validation purposes and should be left unchanged.
