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 FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin 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 yearsWhat 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 DescriptionTotal $BurglarySum Insured Contents $Stock $Tobacco $Combined contents / stock $Other $Other DescriptionMoneySum Insured In Transit $On Premises $On premises outside $Business hours $In Safe $Personal custody $Other $Other DescriptionGlassSum 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 businessDo you import products? No Yes Product 1Country of origin 1Product 2Country of origin 2Product 3Country of origin 3TransitOwn 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 unitsUnits $Air ConditionerAmount of unitsUnits $OtherAmount of unitsUnits $General PropertyDescribe equipment you wish to insure 'away from your business' (e.g. laptop computers)Sum InsuredTax AuditSum Insured $Employee FraudSum Insured $Motor VehiclesMake and modelYearRegistration NumberMain DriverDate Of Birth DD slash MM slash YYYY The vehicle is garaged No Yes Garage postcodeNCB rating or rating numberUse 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.
