Retail Insurance Proposal Form

Retail Insurance Proposal Form
Business Name
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal Code
Primary Trade / Occupation
Business Description
Cover - Sums Insured:

General contents, including fixtures and fittings, and tenant improvements (please enter the required sums insured below).

	Total Sums Insured £
General Contents including Fixtures & Fittings and Tenants Improvements
Computer on Premises
Special Stock - Wines/Spirits & Tobacco
Special Stock - Clothing / Electrical / Audio & Visual
Stock
Stock in the Open
Public Liability £2,000,000 (Standard)
Building Insurance Sums Insured (if applicable)

How many years has the business been trading continuously claim and loss free (including incidents or accidents that could give rise to a claim)?
Business turnover ? *
Additional Information or Special Requirements
Policy Start Date

MonthDayYear
Date

Contact us: Telephone: 0203 488 7193 - Email: info@capitalindemnity.co.uk Within our office hours, we endeavour to contact you within 15 minutes of your requested time. Office Address: Duke House, 15 Seymour Street, London, SE18 6SX
Should be Empty: