Retail Risk
Code (For Office Use Only)
Details taken by
Please Select
Niall
Amanda
Mark
Sharon
Gerry
Ann Marie
Phone or Counter Call
Phone
Customer in the Office
Date
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Hour Minutes
Business Name
Name
*
First Name
Last Name
Risk Address
*
Address Line 1
Address Line 2
City/Town
County
Eircode
Number Of Years In Business
*
Email
*
Phone Number
*
Format: (000) 000-0000.
Cover Date/ Renewal Date
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Full Business Description
*
Example cafe, newsagents
Property Section
Material Damage
*
Rows
Sums Insured
Buildings
Contents/Fixtures & Fittings
Frozen Foods
Stock
Tenants Improvements
Tobacco
Coal/Gas
Wines/Spirits
Construction Details of the Premises
*
Rows
Details of property
Walls
Roof
Floors
Number of Storeys
Year of Building
Security & Fire Precautions
*
Rows
Details of Same
CCTV
Yes
No
N/A
Burglar Alarm
Yes
No
N/A
Is it Monitored
Yes
No
N/A
Fire Alarm
Yes
No
N/A
Is it Monitored
Yes
No
N/A
Is there Anti Ram bar
Yes
No
N/A
Is there shutters
Yes
No
N/A
Key Locks on Windows and doors
Yes
No
N/A
Is there deep fat frying if so what %
Business Interruption
Rows
Required Amount
Rent Payable
Gross Profit
Indemnity Period
Money Cover
Rows
Limits Required
On The Premises During Business Hours
On the Premises Outside of Business Hours
Money in Transit Cover
Money in Bank Night Safe
Public/Product Liability
*
Rows
Limit Required
Public Liability
€2,600,000
€6,500,000
Products Liability
€2,600,000
€6,500,000
Gross Annual Turnover
Your Total Turnover
Employers Liability Section
*
Rows
Number of Employees
Annual Wages
Number of Full Time Employees
1
2
3
4
5
6
7
8
9
10
N/A
Number Of Part Time Employees
1
2
3
4
5
6
7
8
9
10
N/A
Any Claims In The Last 5 Years
*
Please Select
Yes
No
If Yes please provide Full Details
Any Additional Information
How Did You Hear About Us
*
Please Select
Facebook
Google Search
Radio Ad
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