GH Insurance

Enquiry Form for Commercial Combined

Please fill in the form below.

* Required fields

CLIENT DETAILS
* Name of proposer or company
* Risk Address
* Postcode
* Contact Name
	Different Contact Address
* Contact Address
* Contact Postcode
* Telephone
Fax
* Email Address
BUSINESS DETAILS
* Full description of your business
* Date established (YYYY-MM)
PREMISES DETAILS
* Are the premises built of brick, stone, concrete and entirely of non combustible materials?
* Details
* Are the roofs built of slates, tiles, concrete and entirely of non-combustible materials?
* Give details and % of any flat roof
* Are the premises listed?
* Is the premises fully occupied?
* Details
* Please select the current security	Nacoss approved redcare alarm Nacoss approved central station alarm Other audible alarm Shutters / grills Mortice dead-locks Night watchman / guard Live on premises Other
If other then specify here
* Do you have a sprinkler system?
SUMS INSURED
* Buildings (£)
* Tenants improvements (£)
* Stock (£)
* Machinery and Plant (£)
* Contents (excluding electronic business equipment) (£)
* Electronic business equipment (£)
* Laptop computers (£)
* Loss of rent payable (£)
* Indemnity period
* Glass (£)
* Money (£)
* Goods in Transit (£)
* Loss of Profit/ Business Interruption (£)
* Additional Cost of working (£)
LIABILITY
Employers Liability: £10,000,000
* Estimated Wageroll: Clerical (£)
* Estimated Wageroll: Manual (£)
* Public/products liability (£)
* Estimated Turnover (£)
CLAIMS
* Have you made any claims within the past 5 years?
* Details
* Has a policy ever been cancelled or have special terms been imposed?
* Details
* Renewal Date (YYYY-MM)
If you have any further insurance requirements or material facts which should be disclosed to underwriters please give details