Restaurant/Takeaway Insurance Quotation Form
Agent Name:
*
Please Select
Mohammed Sumidh
Mohammed Hussain
Mukit Miah
Johid Foridi
John Morisson
Masrur Ahmed
Salman Ahmed
Azid Miah
Proposer's Business Details
Proposers Name:
*
Mr/Mrs/Miss
First Name
Last Name
Trading name:
*
ERN Number (if Known)
Is the business:
Please Select
Restaurant & Take Away
Restaurant Only
Take Away
Cafe
What type of cuisine do you provide:
Is the business licensed (i.e. serves alcohol):
Yes
No
Date business established:
Do you have a frying range:
Please Select
Deep Fat Fryer
Table Top Fryer
Non
Risk address to be insured:
*
Number / Street Address
Address Line 2
Area
City
Post Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Opening hours of premises:
Do you do home deliveries:
Yes
No
Do You Require Outside Catering Insurance:
Yes
No
About The Building
What cover do you require:
*
Please Select
Buildings Only
Business & Contents Only
Building and Contents
Liability Only
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)
Please Select
Not listed
Grade 1
Grade 2
Grade 3
Constructed of brick, stone or concrete and roofed with slates, tiles, concrete, metal or asbestos sheeting, no more than 25% asphelted flat roof?
Yes
No
Other
Maintained in a good state of repair?
Yes
No
Occupied by you in connection with your business and also as private dwelling?
Yes
No
Heated by low pressure hot water apparatus, fixed gas appliances or fixed electrical appliances?
Yes
No
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:
Do you require legal expenses cover?
Yes
No
More About The Insured And Premises
Has the Insured or any director or partner been declared bankrupt, insolvent, been convicted of or has any prosecution pending for arson or any offence involving dishonesty of any kind?
Yes
No
Has any previous insurer declined a proposal, refused to renew a policy or imposed any special terms or conditions?
Yes
No
Has the Insured or any director or partner incurred any loss, destruction or damage or had any claim made against them in the last 5 years?
Yes
No
Are the premises in an area which is exposed to damage by storm, flood, subsidence, heave or landslip, or near a river, sea, watercourse, cliff or quarry?
Yes
No
Does the Insured undertake to work away from the premises?
Yes
No
Does any other business occupy or operate from these buildings?
Yes
No
Is there a children's play area at the premises?
Yes
No
Is there a safe at the premises?
Yes
No
If the answer is 'Yes' to any of the above, please provide full details here:
Security Alarm
Please Select
Bell Only
Red Care (maintained)
Telephone Ring
CCTV
Yes
No
Shutters
Yes
No
Are all exit locks fitted with a BS3621 British standard Locks or 5 Lever
Yes
No
Does the risk have Fire extinguishers to scale?
Yes
No
Is a Fire alarm fitted
Yes
No
does the fire alarm have remote signalling?
Yes
No
Current Insurance and Contact Information
Renewal/Inception date:
*
-
Day
-
Month
Year
Date Picker Icon
Current insurers (If applicable):
Renewal/Target premium:
Contact name:
E-mail:
Telephone number:
*
Preferred choice of quotation contact:
Please Select
Telephone
E-Mail
Post
In person
Preferred payment method:
Please Select
Direct Debit
Debit Card
Credit Card
Cash
Cheque
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)
*
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