Commercial Buildings Insurance

This on-line form is for a quote for Commercial Buildings Insurance.
Please complete all the questions to enable a quick response.

Applicant
Full Name
Address
Postcode
Telephone
Fax
Email
   

Insured Details
Insured Name
Address of Property
Postcode
   
Date Property Purchased
No.of tenants in last 5 years
Buildings Current Occupation
Name Of Tenant

NB. If Property Is Vacant Please State ‘Vacant’

Property Details
Age of property
No. of storeys
Is property listed?
Yes No If yes, why
Construction


Walls Roof Floor

If Other please state:

If any portion of the roof is flat, please answer the following:
How much
%
Construction
If Timber/Asphalt – last year renewed
Are there any adjoining premises? Yes No

If Yes is there a complete firebreak wall between them and the insured premises?		 Yes No

Sums Insured
Buildings declared value
£
(we will add an inflationary provision)

Rent sum insured (per annum)

£
Indemnity Period
Contents sum insured
£
Property owners liability
(Limit of Indemnity)
£

Employers liability – wage roll
(Required for maintenance staff)
£
Property Maintenance
Is there a managing agent in force? Yes No
Are electrics subject to qualified checks every 5 years? Yes No
Is waste stored in non-combustible containers and regularly removed? Yes No
Is there a no smoking policy in force? Yes No

Claims History
Date Type of Claim/Cause
 Paid Outstanding Action taken to avoid recurrence
£ £
£ £
£ £
£ £

Other Information
Holding Broker? Yes No
Current Insurer
Any other Insurer/Broker approached for quotation? Yes No
Renewal date
Target premium
£
Is a terrorism quote required? Yes No
Deadline date
Date
Any Other Information
 Langley House
 249 Broadway, Bexleyheath,
 Kent DA6 8DB
Tel: 020 8298 1707 
Fax: 020 8298 0699