Surgery Insurance Quote Please enable JavaScript in your browser to complete this form.1Your Details 2About the Proposer3Surgery Buildings details4Cover Details5Claims DetailsYour 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 *DoctorsDentistClinicHow long have you owned the property? *Postcode & 1st line of the address of the building: *Year of Build *Are you insuring the whole building?: *YESNOIf No, which part of the building are you insuring?NextSurgery Buildings InsuranceIs 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 subject to a preservation order?Has the property suffered from, or shows any visible signs of damage from subsidence, landslip or ground heave? *YESNOIs the Building heated by FIXED Gas, Electric or Oil Central Heating? *YESNODo you have a sprinkler system *YESNOHave you had a fire risk assessment *YESNOHave you had your electrical installations tested *YESNOAre the premises protected by an intruder alarm? *YESNOIs the alarm maintained under a contract *YESNOAre the premises within a covered and locked shopping centre or mall that is partolled by security guards or grilles? *YESNOAre bars fitted to all easily accessible rear and side windows? *YESNOIs there a residential section to the property? *YESNOAre the premises occupied overnight by the proposer or a family member or employee of the Proposer? *YESNOAre the premises more than 25 metres away from the nearest river, canal, lake or tidal waterway? *YESNODescription of neighbourhoodRuralVillageTownCityWhat is the Declared Buildings Sum Insured (the lower one on your present schedule if you have one or the cost to rebuild your property)? Is cover required for subsidence? *YESNOPreviousNextCoverPlease confirm value of stock £0£2500£5000£7500£10,000£12500£15,000£20,000£25000more than £25,000What level of cover do you need for all other ContentsPlease key in requred limit for Computer Equipment, if requiredPlease key in required limit for Business records, if requiredPlease key in the tenants improvements sum insured, if required, otherwise leave blankPlease key in the required limit for money on the premises during business hours, in transit or held in a bank night safe until removed by a bank official if required, otherwise leave blankPlease key in the required limit for money contained in a locked safe outside business hours if required, otherwise leave blankDo you require cover for loss of rent? *YESNODo you need Employers Liability Cover - £10,000,000? *YESNODo you need Public Liability Cover - £5,000,000? *YESNODo you require Legal Expenses Cover? *YESNOIs Terrorism Cover required? *YESNOIs Employee dishonesty cover required? *YESNOPreviousNextClaimsHave you ever had any claims or incidents at these or any other premises in the last 5 years?: *YESNOIf yes please provide details of Date/Loss Type/CostDate of renewalNameSubmit Quote Form