| General Questions |
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Name:
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Company Name(if different): |
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Business:
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Address:
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Phone:
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Email:
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| Current Insurance Details |
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Current Insurer:
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Renewal Date:
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Number of Years in Business:
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| Claims History |
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Are there any Claims within the past 5 Years:
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YesNo
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| Property Cover |
| Please tick type of cover required : |
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Accidental Damage including Subsidence
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Accidental Damage excluding Subsidence
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Fire/perils only
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Is theft cover required:
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YesNo
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| Sums Insured |
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Building :
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€
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General Contents (Excluding Computers) :
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€
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Stock :
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€
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Tenants Improvements :
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€
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Tobacco & Equipment :
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€
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Photographic Equipment :
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€
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Deeds, Documents & Transparencies :
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€
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| Specified Items (Please detail any items to be used away from premises) |
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Is the building of standard construction(constructed of non-combustible materials)
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YesNo
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Please tick if any of the following are in the premises
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Fire Extinguishers
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Hose Reels
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Fire Alarm
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Sprinkler System
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Is there an intruder Alarm connected to a Central Station
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YesNo
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Does Owner or Staff Member live on premises?
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YesNo
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Is the Shop an internal unit in a shopping centre
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YesNo
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| Business Interruption |
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Gross Revenue :
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€
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Additional Cost of Working :
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€
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Indemnity period :
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12 months
18 months
24 months
36 months
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| Employers Liability – €13,000,000 Limit of Indemnity |
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Does the Wageroll exceed €500,000
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YesNo
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if yes state Wageroll
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| Public Liability cover |
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€1,300,000
€2,600,000
€6,500,000
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Basis of Cover
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Public Liability onlyPublic/Products Liability
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If Public/Products Liability cover is required please complete the following
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Description of Turnover
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Estimated Wages
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If Wholesale
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Wholesale
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YesNo
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Are any products sourced outside the EU
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YesNo
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Have any rights of recovery been waived in respect of these products
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YesNo
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Are any of your products exported to the USA or Canada
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YesNo
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If Club
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Club
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YesNo
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Is member to member Liability cover required
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YesNo
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If Manufacturing
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Manufacturing
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YesNo
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Will any of the products have an end use in Automotive, Aeronautical or Medical Industries
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YesNo
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If Hairdresser/Barber
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Hairdresser/Barber
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YesNo
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Number of Qualified Stylists
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| Money Cover |
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In Premises/Transit/Bank Night Safe(Standard €10,000)
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Required €
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Money in unspecified safe ( Standard € 2,500)
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Required €
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