Name
*
First Name
Last Name
Email
*
Trading Name
Trading Style
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
Occupied Solely by you?
*
Please select
Yes
No
In a good state of repair
*
Please select
Yes
No
Built of brick, stone, concrete or with walls of other incombustible or fire resistive material and roofed with slate, tiles, metal, asbestos or concrete?
Please select
Yes
No
If "no" please provide details
Are all external doors fitted with either a multi-point locking system or a 5-lever mortice deadlock which is British Standard 3621?
*
Please select
Yes
No
Are all accessible windows fitted with locks having removable keys?
*
Please select
Yes
No
If "no" or you are in doubt please give details of makes and types of locks fitted:
Are the premises alarmed?
Yes
No
Type of signalling? (Central Station, BT Redcare or Bells only)
Is the alarm system maintained under contract?
Yes
No
Age of building
Which floor(s) do you occupy?
Please give details of any other security (eg 24 Hour security gaurds, CCTV, strong rooms or safes (with make and model))
Stock at premises and/or bank vault (£)
Stock at exibitions, stamp fairs and shows (£)
Number of UK exhibitions, fairs or shows anticipated in one year
Number of overseas exhibitions, fairs or shows anticipated in one year
Stock at any other premises in the UK (excluding shows etc) (£)
Estimated total value of annual sendings in UK (£)
Estimated total value of annual sendings overseas (£)
Office Contents - Value of office contents (£)
Is accidental damage cover required?
Yes
No
An application for insurance refused?
Yes
No
Renewal of such insurance refused or cancelled?
Yes
No
Increased premium or special terms and restrictions imposed?
Yes
No
Any losses by any of the risks to be covered within the last five years?
Yes
No
If "Yes", please give details
I agree to the above declaration:
Yes
No
Date
