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Insurance Quotation Request Form For Marquee Hirers

Company name(*):		Telephone:
Contact name(*):		Fax:
	Ltd Trading	Mobile number(*):
Correspondence address:		Email(*):
Postcode:

Premises/storage address:
Postcode:


	Type of equipment:		If other please specify :

	How many years have you been trading: years

	If none, please detail previous experience in erecting marquees:
	Please specify the main manufacturer of your marquees:

	Maximum span of your marquees:
	Current Insurer:
	Current Broker:
	The Renewal Date of your existing policy:		(dd/mm/yy)

	Have you ever been declined a Proposal by Insurers?		Yes No
	Have you ever had a renewal not invited by Insurers?		Yes No
	Have you ever had special terms imposed by Insurers?		Yes No
	Has an Insurer ever refused or cancelled your insurance policy ?		Yes No
	Have you ever had any criminal convictions?		Yes No
	Have you ever been declared bankrupt?		Yes No
	If you have answered 'Yes' to any of the above please provide further details:
	Have you had any claims, or incidents that would have resulted in a claim if you had had the proposed Insurance, within the last 5 years?		Yes No
	If you have answered 'Yes' please provide dates, types of claims and amount paid and reserved by insurers:



Material Damage
	Do you require cover for Damage or Loss to your stock?	Yes No
	If you have answered 'Yes' please answer following questions:
	Are your storage premises of Standard Construction?	Yes No
	Are your premises in your Sole Ocupation?	Yes No

	If you have answered �no' to the premises being in your sole occupation, then please give details of persons or businesses that occupy the same premises as you or have access to your premises below and detail their type of business or reason for their access:


	Are your premises protected by an intruder alarm?	Yes No
	If yes, please specify what type of alarm:
	If other, please specify:

	Please provide the figures of the covers you wish a quotation for below :

	Buildings :
	Contents (Non Computers) :
	Contents (Computers) :
	Tools and Laptops:
	Total replacement value of all of your stock :

	Please confirm whether the firgures given above relate to Reinstatement values (New or Old) or Indemnity values (SecondHand)
	Reinstatement Indemnity

	Please specify the geographical limits required:

	Would you like to include Goods in Trust on your policy :	Yes No
	If yes, please provide us with the replacement value of the total amount of hired goods you would have at any one time:

	Would you like a quotation for Business Interruption Cover :	Yes No
	Please provide us with your Annual Gross Profit figure:


Public Liablity
	Do you require Public Liability Cover?	Yes No
	If yes, please provide us with your estimated turnover for the next 12 monts.:
	Please select the indemnity limits you would like a quotation for: �1m �2m �3m �5m Other


Employers Liability
	Do you require Employers Liability Cover?	Yes No
	If you have answered 'Yes' please provide us with the following:
	How many full time employees do you have?
	What is your estimated Manual Wage figure for next 12 mths?
	What is your estimated Clerical Wage figure for next 12 mths?

	Do you manufacture any goods for sale/repair or own use?

	If you have selected 'Sales' please tell us what percentage of your turnover is reflected by manufacture: %



Health and Safety
	Do you have a current Health and Safety Policy?	Yes No
	Do you have a formal Employee Training Programme?	Yes No
	Have you carried out Risk Assessments?	Yes No

	A quotation is required by (dd/mm/yy)


	Terms of Business
	I have read and agree with Terms of Business