Restaurant and Take Away Proposal Form

Restaurant/Takeaway Insurance Quotation Form
Agent Name:*
Proposer's Business Details
Proposers Name:*

Mr/Mrs/MissFirst NameLast Name
Trading name:*
ERN Number (if Known)
Is the business:
What type of cuisine do you provide:
YesNo
Date business established:
Do you have a frying range:
Risk address to be insured:*

Number / Street Address

Address Line 2

AreaCity

Post CodeCountry
Opening hours of premises:
YesNo
YesNo
About The Building
What cover do you require:*
If Buildings Cover Is Required: What Sum to be Insured?
Is The Building...... (Please Complete Even If Only Insuring Contents)
Is the Building Listed (Graded)
YesNoOther
YesNo
YesNo
YesNo
If you have answered 'No' to any of the above, Please give details here:
About The Contents

Please give the sum insured required for each category
Category ............................Sum insured (£)
Fixtures, fittings and contents:
Computers & electronic business equipment:
Stock (Excluding items below):
Refrigerated stock:
Tobacco, cigarettes, cigars
Wines and spirits:
Business interruption: Amount Required
Goods in transit:
Fixed glass:
Loss of licence:
YesNo
More About The Insured And Premises
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
If the answer is 'Yes' to any of the above, please provide full details here:
Security Alarm
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
Current Insurance and Contact Information
Renewal/Inception date:*

DayMonthYear
Current insurers (If applicable):
Renewal/Target premium:
Contact name:
E-mail:
Telephone number:*
Preferred choice of quotation contact:
Preferred payment method:
Any other info:
Please now submit the restaurant quotation form through to our office to arrange your quote.
Signed by Policy Holder (Confirming all details provided is correct)*
Should be Empty:

Restaurant/Takeaway Insurance Quotation Form

Proposer's Business Details

About The Building

Is The Building...... (Please Complete Even If Only Insuring Contents)

About The Contents

Category ............................Sum insured (£)

More About The Insured And Premises

Current Insurance and Contact Information

Please now submit the restaurant quotation form through to our office to arrange your quote.