Licensed Premises

Name

Full Names

Risk Address

Trading style

Business Name e.g Joe Bloggs Ltd T/a Joe Bloggs Inns

If you're a sole trader or partnership please enter Mr Joe Bloggs T/a The White Horse

Type of Insurance Required

Public House-Buildings, Contents and Liabilities

Public House-Contents and Liabilities (No Buildings Insurance Required)

Renewal Date

If you are currently uninsured please enter today's date

Sums Insured

	Enter amount in £ or N/a
Reinstatement Value Buildings
Trade Contents
Fixtures and Fittings
Domestic Contents
Beer
Wines and Spirits
General Stock
Electronic Office Equipment
Money on premises during open hours
Money in a safe overnight
Goods In Transit

Please enter make of safe if you require more than £2000 limit.

Sums Insured Continued

Public liability-please choose £2 or £5 million. Employers liability is always £10 million

Further Info

Building Information

	Answer
Year of Build
Location i.e High Street
Brick or stone built?
Listed? I.e Grade 2
Central Heating Type
Floor construction i.e Timber
Flat Roof area %
Property ever affected by flood
Letting Rooms
Childrens Play Area?
Type of deep fat fryers on site

Security Details

	Answer
Who lives on the premises
Type of Burglar Alarm
Type of Fire Alarm
Door locks on external doors
Window locks on opening windows
CCTV?
Is CCTV recorded?
ATM on the premises?

Burglar alarm i.e Audible only/Redcare/Dual com

Credit and Claims History

	Yes	No
Any Adverse Credit History
Any claims in 5 years?
Any pending claims?
Ever had insurance cancelled

Adverse credit is bankruptcy, insolvency, CCJ's etc.

If you answered yes to anything above please give more info here:

Dates, amounts, settlement dates etc. General Circumstances