Pub Insurance Quote Form Please enable JavaScript in your browser to complete this form.1Your Details2About the Proposer3Building Insurance Details4Stock and Other Contents5Past ClaimsYour DetailsName of Policyholder *Status of Policyholder *Limited CompanySole TraderLandlordDate Company established (if applicable)Name of Contact *FirstLastYour Contact Number *Email *NextHas the Proposer(s), or any Partner(s) or Director(s) ever been:a) convicted, cautioned or currently have any prosecutions pending against them regarding any criminal offence, other than a motoring offence? *YESNOb) refused insurance, had special conditions imposed by an Insurer, had any insurance terminated or been refused renewal of such insurance? *YESNOc) declared bankrupt, or had a company become insolvent or voluntarily gone into liquidation or Compulsory liquidation? *YESNOd) disqualified from being a company director? *YESNOBusiness Type *Public HouseWine BarCocktail BarPostcode & 1st line of the address of the building: *NextBuilding InsuranceWhat is the Declared Buildings Sum Insured (the lower one on your present schedule if you have one)? Is the building subject to a preservation order? *YESNOIs cover required for subsidence? *YESNOHas the property suffered from, or shows any visible signs of damage from subsidence, landslip or ground heave? *YESNOIs the Building constructed only with walls built of brick, stone or concrete? *YESNODoes the Building have a roof constructed only of slate, tile, metal or concrete? *YESNOif no, please provide details:What percentage of the roof is flat (0-100%)? *What is the construction of the flat roof if there is one (ie. felt on timber)? *How many floors are there (including any basement)? *Is the Building heated by FIXED Gas, Electric or Oil Central Heating? *YESNOIs there an ATM on the premises *YESNOIs hot food on the premises? *YESNOIs deep fat frying performed on the premises? *YESNOIs overnight accommodation provided by paying guests? *YESNODo you have a sprinkler system *YESNOHave you had a fire risk assessment *YESNOHave you had your electrical installations tested *YESNOIs your propertyLocated on or near to a cliff? *YESNOLocated or or near a lakeside? *YESNOLocated on or near to the riverside? *YESNOLocated on or near to a sea front? *YESNOLocated in an area prone to flooding? *YESNOOccupied overnight by he proposer or a family member or employee of the Proposer? *YESNOWithin an area with 24 hour CCTV camera monitoring? *YESNOFitted with bars to all easily accessible rear and side windows? *YESNOProtected by an intruder alarm? *YESNOProtected by a sprinkler system? *YESNONextStock and other ContentsPlease confirm value of stock Less £2000£2500£5000£7500£10,000£12,000£15,000£20,000£25000more than £25,000Is cover required for the deterioration of chilled or frozen food? *YESNOWhat level of cover do you need for all other Contents *Less £2000£2500£5000£7500£10,000£12,000£15,000£20,000£25000more than £25,000Is cover required for loss of liquor licence *YESNOHas there been any opposition to or any incident that may prejudice the granting, renewal or transfer of the licence? *YESNOHas the proposer or licence holder ever had an application for the granting, renewal or transfer of the licence refused? *YESNOThird ChoiceIs there an intention to apply for a transfer of the licence within the next 12 months? *YESNOThird ChoiceSum to be insured for loss of licence *Less £5000£5000£10,000£15,000£20,000£25000more than £25,000Do you provide any of the following entertainment (please tick which apply) *NoYesBouncy castlesCabaretLive MusicThemed nightsFirework displaysDancing/dance floorDisc JockeyKaraokeDo you require cover for business interruption *YESNOIf Yes - what limit (£) and over what period (Years & Months)Do you require cover for book debts? *YESNOIf yes, what limit? *£5000£10,000£15,000What level of public liability cover do you require?£200,0000£500,0000Do you need Employers Liability Cover - £10,000,000 *YESNOIs Terrorism Cover required *YESNOIs Employee dishonesty cover required? *YESNONextClaimsHave there been ny claims or incidents in the past three years which have or could have resulted in a claim in respect of the covers requested *YESNOIf yes please provide details of Date/Loss Type/CostDate of renewalNameSubmit Quote Form
