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Company Name                                                           Date Established                       
   
Address                                                                        Postcode                                   
   

MAIN CONTACT INFORMATION                                                                                  
Title                  First Name                                        Last Name                                  
Mr Mrs Miss Ms Dr           
Telephone Number                                     Mobile Number                                          

Fax Number                                                E-mail address                                           

YOUR BUSINESS                                                                                                         
Business Activities (please tick all that apply)
Body Repairs                  Spraying            Vehicle Sales
                                                      
Mechanical Repairs/Service                          MOT Testing   
                                                                         

YOUR PREMISES                                                                                                                     
Do you operate from more than one location?                                                    NO YES
If you trade from multiple locations please complete this form for your main location              
and we will contact you to discuss other locations                                                                   .
Are your premises of standard construction?                                                        NO YES
(Built only of brick, stone, concrete, concrete block or insulated metal cladding                        
with slate or tile supported by timber framing, metal, asbestos or concrete roof)                        
Are you the sole occupant of your property?                                                       YES NO
Are any areas of your property unoccupied?                                                       NO YES
Do you use portable Gas / Oil heaters at your premises?                                    NO YES
Do you have a NACOSS approved REDCARE alarm system?                            NO YES

Building Sum Insured                                Tenants Improvements                               
         
Loss of Rent (receivable / ayable)               Computer Equipment                                
         
Stock (excluding vehicles)                           All other contents / property (ex vehicles)   
         
                                                      Vehicle Stock                                                        
                                
What is the approximate percentage value of vehicles on your premises over night:                
Inside the buildings                                                           
In an enclosed, secure area outside the buildings             
Elsewhere in the open                                                       

POLICY COVER INNER LIMITS                                                                                                
Portable Hand Tools Sum Insured                STANDARD LIMIT £10,000 £15,000 £20,000 £25,000 I will discuss my requirements with you
Vehicle Entertainment Equipment               STANDARD LIMIT £10,000 £15,000 £20,000 £25,000 I will discuss my requirements with you
Property Whilst in Transit                              STANDARD LIMIT £15,000 £20,000 £25,000 I will discuss my requirements with you
Exhibition Cover                                           STANDARD LIMIT £10,000 £15,000 £20,000 £25,000 I will discuss my requirements with you
Contents of Customers Vehicles                     STANDARD LIMIT £5,000 £7,500 £10,000 I will discuss my requirements with you
Deterioration of Stock                                   STANDARD LIMIT £1,000 £2,000 £3,000 £5,000 I will discuss my requirements with you
Cigarettes/Tobacco/CD's/Videos/.....             STANDARD LIMIT £2,500 £5,000 £7,500 £10,000 I will discuss my requirements with you
..../Alcohol/Clothes                                                                                              
Do you require Road Risks Cover?                                                                       YES NO
Do you require Comprehensive cover?                                                                YES NO
How many trade plates do you have?                                                                   

How many vehicles do you have for business use? Please Split into the following categories:

Recovery Vehicles                                                                                           
Passenger Carrying Vehicles with 8 or more seats                                           
Courtesy Cars                                                                                                  
Other Vehicles                                                                                                
Does the value of any vehicle exceed £50,000?                                                 NO YES
How many people will drive cars whilst on your business                                
How many people will use YOUR cars for private use                                     
Do you want to insure any vehicles not registered in your co. name?                  NO YES
Will any of YOUR vehicles to be used for business other than yours?                  NO YES
Has any person who will drive had any motoring convictions?                            NO YES
Does any person who will drive suffer from any medical condition?                    NO YES
Do you wish driving to be restricted to NAMED persons only?                             NO YES

ENGINEERING PLANT / INSPECTION                                                                                      
Do you require cover for Engineering Plant / Inspection?                                   YES NO
If yes please specify:                                                                                                                  
Type of Plant                          Power / Load                             Value                       
       
       
               

LIABILITY INSURANCE                                                                                                             
Public Liability Insurance                             STANDARD LIMIT £2million £5million I will discuss my requirements with you
Employers' Liability                                      STANDARD LIMIT £10million I will discuss my requirements with you
What is your estimated annual turnover for the coming year?           
What is your estimate of the total payments to employees (including labour only                     
sub-contractors) for the forthcoming year split by the following categories:                                  
Clerical, Sales and Managerial Staff?                                              
Woodworking, power press, guillotine/sheet metal operators?           
Breakdown and Recovery operators?                                                 
All other manual employees?                                                           
Total number of employees?                                                            

BUSINESS INTERRUPTION INSURANCE                                                                                 
What is your estimated Gross Profit for the forthcoming year?           
Period of Indemnity Required                                    STANDARD PERIOD 12 months 24 months 36 months

GENERAL QUESTIONS                                                                                                            
Do you have a written Health & Safety Policy?                                                   YES NO
Current / Previous Insurer?                                                                  Allianz Cornhill AXA Lloyds NIG None Norwich Union Tradex Other
Current Renewal Date?                                                                     
Current Annual Premium?                                                                
Has any insurer declined to quote / renew or imposed special terms?                 NO YES
Has any Director or partner been:                                                                                              
declared bankrupt or insolvent?                                                                          NO YES
involved with a company that went into liquidation or was dissolved?                NO YES
convicted or charged with a criminal offence (other than motoring)?                  NO YES

prosecuted for breach of statute relating to health and safety                                                    
                                                                 of employees or others?                    NO YES
served with a prohibition notice under the health & safety at work act?              NO YES

Please acknowledge that you wish Sunninghill Insurance Brokers Ltd to contact  you for a free no obligation review of your insurance requirements:

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