Quote for Food, Eateries & Pubs
Disclosure
Please ensure that the information provided by the Proposer and the statement on these pages are correct and that you disclose material circumstances to make a fair presentation of the risk. Should the Proposer decide to proceed with the quotation, these details will form the basis of the insurance contract. Incorrect information could invalidate all or part of the Policy. Please confirm that the Proposer agrees to the following statements:
Neither the Proposer, nor any directors or partners in the business have ever -
Had an insurance contract cancelled by an insurer?
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Yes
No
If Yes
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Had an insurance contract declared void by an insurer?
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Yes
No
If Yes
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Had different terms applied to an insurance contract by an insurer due to misrepresentation by: - Providing misleading or incorrect information - Deliberately or recklessly withholding information - Providing false documents.
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Yes
No
If Yes
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Had insurance cover restricted or cancelled due to non-compliance with risk improvement requirements?
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Yes
No
If Yes
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Been convicted of or charged with but not yet tried for a criminal offence other than motoring offences?
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Yes
No
If Yes
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Health & Safety
Neither the Proposer, nor any directors or partners in the business either personally or in connection with the business or in any other business capacity has ever been:-
Convicted of (or charged but not yet tried with) a breach of any UK health and safety legislation by any official body regulatory authority or enforcing authority?
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Yes
No
If Yes
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Served with a prohibition notice or improvement notice in connection with any UK health and safety legislation by any official body regulatory authority or enforcing authority?
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Yes
No
If Yes
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Served with a clean-up notice in connection with any UK health and safety legislation by any official body regulatory authority or enforcing authority?
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Yes
No
If Yes
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Served with a clean-up notice in connection with any UK health and safety legislation by any official body regulatory authority or enforcing authority?
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Yes
No
If Yes
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All lifting plant and pressure vessels/boilers which are subject to Statutory Regulations are regularly inspected by qualified engineers as required by the legislation?
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Yes
No
If No
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To the best of their knowledge the proposer complies with their legal obligations under UK health and safety legislation?
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Yes
No
If No
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Financial
Neither the Proposer, nor any directors or partners in the business or in the name of any other business which any of us had an interest have -
Been declared bankrupt or insolvent either as private individuals or in connection with any business within the last ten years?
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Yes
No
If Yes
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Been disqualified from holding a directorship?
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Yes
No
If Yes
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Been the subject of a County Court Judgement (or the Scottish equivalents) in respect of debt as private individuals or in connection with any business within the last six years?
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Yes
No
If Yes
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Been a director or partner in a business that has been the subject of a County Court Judgement (or the Scottish equivalents) in respect of debt within the last six years?
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Yes
No
If Yes
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Been officers of a company that has been declared insolvent, or had a receiver or liquidator appointed, or entered into arrangements with creditors in accordance with the Insolvency Act 1986 within the last ten years.?
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Yes
No
If Yes
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When answering the above questions, you are confirming on behalf of the Proposer that the statements above are true and if this quote is converted to an insurance policy, it will form the basis of any contract of insurance affected thereon. Please provide all details relevant to the quotation.
Client Details
Inception Date
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-
Day
-
Month
Year
Date
What is the Business Status?
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Please Select
Sole Trader
Partnership
Limited Company
Non-Limited Company
Charity Organisation
Limited Liability Partnership
Proposers name and trading name in full
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Title
*
Please Select
Mr
Miss
Mrs
Ms
Other
If Other
*
Name
*
First Name
Last Name
Gender
*
Please Select
Female
Male
Not Applicable
Phone Number
*
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
County
Postal / Zip Code
Type of Risk
*
Please Select
Cafe
Fish & Chip shop
Public House
Restaurant
Sandwich Shop
Take Away
Other
If Other
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Employer PAYE Ref (Leave blank if Exempt)
Is the Client ERN Exempt?
*
Please Select
Yes
No
Awaiting Certification from the HMRC
UK businesses employing one or more people are required to have an ERN (Employer’s Reference Number, also commonly referred to as the ‘Employer PAYE Reference’), which is a unique reference number for your employees’ income tax and national insurance contributions. You will find your ERN printed or written on mandatory documents including the P45, P60, P11/D and on most payslips. It looks something like this: 123/AB12345 (Maybe with up to 7 digits)
If No - Employers Reference Number
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-
Is there a third- party premises to be insured?
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Yes
No
If Yes
*
Risk Address
*
Street Address
Street Address Line 2
City
County
Postal / Zip Code
Number of years trading at this address?
*
Please Select
0
1
2
3
4
5
or more
Number of years trading at previous address?
*
Please Select
0
1
2
3
4
5
or more
Please give full details of any previous Ownership/ Managerial experience with the same trade -
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Premises
The Premises/ Buildings of the business being proposed
Have walls built of Brick, Stone or Concrete?
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Yes
No
If No
*
Have a roof of slate, tile, metal or concrete, excluding any flat roof area?
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Yes
No
If No
*
Has a flat roof percentage of?
*
Are in a good state of repair and kept in a like manner?
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Yes
No
Have a listed status?
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Yes
No
If Yes
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Please Select
Category A (Scotland)
Category B (Scotland)
Category C (Scotland)
Grade 1 (England & Wales)
Grade 2 (England & Wales)
Grade 2* (England & Wales)
Grade A (Northern Ireland)
Grade B1 & B2 (Northern Ireland)
Grade B+ (Northern Ireland)
Were built in what year?
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Please Select
Pre 1850
post 1850
Located in a shopping centre, arcade or mill complex?
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Yes
No
If Yes
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I.e what type of building, what floor, etc
Trade all year round?
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Yes
No
If No
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i.e. when is the business closed, does the owner/employee live on whilst the premises are closed, etc
Entirely self contained? i.e. with a separate lockable entrance and exit
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Yes
No
If No
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Are occupied solely by the business?
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Yes
No
If No, What is the nature of the other Business/ Businesses?
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Have residential accommodation at the premises other than that which acts as the private dwelling of the proposer or their employees?
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Yes
No
If Yes, Is residential accommodation let to Students, Asylum Seekers, Refugees or persons who receive Housing Benefits directly or indirectly?
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Yes
No
Occupied by the proposer, or their employees, overnight?
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Yes
No
Are free from storm exposure and/or are in an area which is free from flooding and at least 400 metres away from the nearest river, canal, lake or tidal waterway?
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Yes
No
If No
*
Are free from, and in an area (within 400m of the premises) which is free from any signs of subsidence, heave and/or landslip?
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Yes
No
If No
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i.e. when did the subsidence/landslip/heave occur, what has been done to the premises since, etc.
Had the Electrical Installation tested by a certified NICEIC, ELECSA or ECA Contractor within the last 5 years and all reported defects remedied?
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Yes
No
Has an open fire, woodburning or multifuel stove?
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Yes
No
Cover Details
Buildings ( Including Subsidence and Landlords Fixtures and Fittings)
*
Loss of Rent
*
Tenants Improvement
*
Trade Fixtures & Fittings, Machinery, Plant and all Other Contents
*
Ex Stock in Trade
Electronic Equipment & Computers
*
including EPOS systems and computerised tills
Stock
*
Including Materials in Trade, the Property of the Insured or held in trust or commission for which the Insured is held legally responsible
Wines & Spirits
*
Tobacco
*
Deterioration of Stock
*
Goods in Transit
*
Money During Business Hours and In Transit
*
Money in Locked Safe outside Business Hours
*
Business Interruption
*
Business Interruption Indemnity Period
*
Please Select
12 Months
18 Months
24 Months
36 Months
Number of Employees
*
Has a Health & Safety Risk Assessment of the premises been carried out? Only answer if 5 employees or more
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Yes
No
A formal procedure is to be established that periodically audits the effectiveness of the companies health and safety documentation and procedures against best practice and to ensure that it reflects the hazards and risks to which the organisation and its employees and visitors are exposed. Once reviewed the documents should be signed and dated by a director and brought to the attention of all employees on a signed receipt basis.
Is there Health and Safety Policy in place?
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Yes
No
Estimated Annual Turnover
*
Estimate Annual Wageroll
*
Employers' Liability is automatically included at £10,000,000 Public and Products Liability is automatically included at £5,000,000
Risk Information
Is frying undertaken at the premises, other than shallow frying?
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Yes
No
If Yes - Are the kitchen and/or canopy hood, range extraction systems and ducting annually maintained and cleaned by professional contractor?
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Yes
No
Is there a full frying range (fish & chip shop style) located and used at the premises?
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Yes
No
If Yes - . Is the Range maintained and cleaned at least once a year by an independent contractor?
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Yes
No
Is a Pressure Cooker used at the premises ?
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Yes
No
Number of Covers
*
What is the Scores on the Doors rating?
*
Please Select
Exempt
0
1
2
3
4
5
Pass & Eat Safe (Scotland)
Pass (Scotland)
Improvement Required (Scotland)
Not yet Assesset
Details can be found on www.scoresonthedoors.org.uk Please note that the rating cannot be transferred from a previous owner
Are any of the following in place at the premises
Are there any guest rooms available to let?
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Yes
No
Event Hire for private functions including Weddings, Birthdays, Christenings, Wakes etc. held more than twice a month?
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Yes
No
Outside Catering?
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Yes
No
If Yes
*
i.e. what services are offered, is any cooking carried out at third party premises, how many employees are involved, how many events are undertaken per year & what percentage of your business derives from outside catering
Live Music / Entertainment?
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Yes
No
Dance Floor?
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Yes
No
If Yes, Is there a written Spillage Policy in place?
*
Door Staff?
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Yes
No
If Yes, Are the door staff licensed and hired from an approved SIA Third Party Agency ?
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Please provide full details: i.e. how often are door staff are used, how many etc?
*
Open after 11pm?
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Yes
No
If Yes
*
i.e. how often are door staff are used, how many etc
Children's Play Area?
*
Please Select
No
Indoor
Outdoor
Indoor & Outdoor
Is Shisha permitted on the premises?
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Yes
No
Do you Provide a delivery service to customers?
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Yes
No
If Yes, How is delivery carried out?
*
Please Select
Own Employees
Third Party Sub-Contractors
Risk Protections
Does the proposed premises comply with the minimum security requirements described below?
*
Yes
No
1) The Final Exit Door of the premises is fitted with either a mortice deadlock / hook lock, which has 5 or more levers with matching boxed striking plate and conforms to BS3621 standard, or a cylinder operated deadlock or a deadlocking multi-point locking system. Timber doors frames to be at least 45mm thick. All aluminium framed doors are to be fitted with a swing bolt type mortice deadlock.
2) All other external doors and all internal doors giving access to any part of the building not occupied by the insured for the purposes of the business, are fitted with either, the security detailed in 1), or two key operated security bolts of doors, fitted approximately 30cm from both the top and bottom of the door.
3) All Cellar Flaps are fitted with the security as detailed in 1), or 5 lever close-shackle padlocks, together with substantial locking bars.
4) All ground floor and basement opening windows and skylights and all other opening windows and skylights, accessible from roofs, balconies, decks, canopies, down pipes or canopies must be fitted with key operated window locks or permanently fixed shut.
Any door or window officially designated to be a Fire Exit by the Fire Authority is excluded from these requirements.
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Yes
No
If No
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i.e type of locks, how they don't comply, etc
Are all accessible windows protected by either solid steel bars or grilles?
*
Please Select
No
Front
Back
Both
Are the premises thoroughly protected by an intruder alarm system, under the sole control of the insured?
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Yes
No
If Yes to the above, What type of alarm is installed?
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Please Select
Audible Only
Audible with dialler to key holder
Digital Communicator to Monitoring Station
Dual path alarm to monitoring station
Single path alarm to monitoring station
If Yes to the above, Who is the alarm maintained by?
*
Please Select
NACOSS/NSI
SSAIB
Other
Is there CCTV on the premises?
*
Please Select
No
Internal
External
Both
Claims & Additional Information
Has the Proposer(s), Partner(s) or Directors(s) suffered a loss, claim or incident (which may give rise to a claim) at these premises, or any other premises, whether insured or not within the last 5 years?
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Yes
No
If Yes
*
Additional information?
Do you want to bring any further information to the underwriters attention?
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Yes
No
If Yes
*
Target Premium
*
Additional Information
*
Once this has been Completed press send, details will be sent to Giles Insurance Consultants, we aim to get back to you within 48 hours.
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