Corporate Clients

Please complete all of the following fields.
**Denotes compulsory field

Name Of Business **

Contact Name **

Contact Number **

Email **

Preferred contact method

Please select Phone Email

Are you a new or existing client?

Please select New Existing

If new, please advise how you got our name

Please select Websearch Recommendation Advertising Other

If existing, please enter your Client Reference if known

Do you currently have Hotel insurance for this business?

Please select Yes No

If yes, what is the renewal date?

D: M: Y:

What is the current annual premium that you pay?

Please complete all of the following fields.

Trade (e.g. Hotel, Guest House)

When was the business established (year)?

Premises Address

Current Annual Turnover

No. of Employees

Estimated Annual Wage roll

Number of Floors

Resident type - tick all that apply

Business

Leisure

Number of bedrooms

Activities: Please choose all applicable activities

Disco

Karaoke

Live Entertainment Excluding Live Music

Live Music

Pool/Snooker

Private Functions

Quiz Nights

Restaurant

Televised Sporting Events

Themed Weekend

Misc. activities not noted elsewhere

Buildings, including Tenants Improvements

Stock

Contents (including Fixtures and Fittings)

Public Liability

Please select £2m £3m £5m £10m

Employers Liability

Please select £10m £20m £30m £50m

Business Interruption Cover

Business Interruption Cover is cover required over 12 or 24 months?

Please select 12 Months 24 Months

Deterioration of stock

Have you had any claims under this type of policy in the past 3 years?

Please select Yes No

If yes, please specify the number

Please select 1 2 3 4 5 6 7 8 9 10

Have any of these claims been settled for more than £2,500 (approx)?

Please select Yes No

Please provide any further details relating to your application (e.g. state if any rooms are let to DSS, students or asylum seekers / list any activities not mentioned above / do premises have current IEE Electrical Certificate? / has building ever been affected by subsidence or underpinned?))