About You.

    Your Name

    Your Address

    Contact Details

    Renewal Date

    About the business.

    Business Name

    Type of business?

    You selected other, please answer below

    Years Established

    Number of seats

    Hygiene Rating

    Cover Required.

    Stock (£)

    Wines & Spirits (£)

    Frozen Food (£)

    Trade Contents (£)

    Do you have an alarm fitted?

    Please select which type

    Is your alarm maintained under an annual contract

    Do you have shutters to your entire shop front?

    Previous Claims?

    Claims in past 5 years?

    Please give details

    When did this occur?

    What were the costs of claim