Contact Butchers Insurance

Name of Policyholder *

Risk Address including postcode *

Contact Number *

Your Email Address *

Please confirm Renewal / Inception date

Occupation *Please select an optionButcher

Number of years trading *Please select an optionPlease adviseNot purchased startedLess than a year1 year2 years3 years4 years5 years6 years7 years8 years9 years10 yearsOver 10 years

What describes your location *Please select an optionHigh StreetArcadeBusiness ParkCovered Shopping CentreDomestic PremisesMarketMarket HallParadePrecinctIndustrial UnitWarehouseShared Premises with Domestic FlatsShared Premises with other business

When was the Building built *Please select an optionPlease advise1980 - Present1951 - 19801901 - 19501801 - 19001701 - 1800Pre 1700

Please provide the number of flats

Please confirm the Tenancy of the flats

Lease HolderWorking ProfessionalAsylum SeekersCare and SupportHoliday HomeLocal AuthorityRetiredSecond HomeStudentUnemployedUnemployed with BenefitsWorking with Benefits

Please confirm the Commercial tenancy of the premises

Building or Tenants Improvement sum insured

Contents sum insured *

Stock sum insured *

When your premises is closed or left unattended, it is protected by an intruder alarm, installed and maintained by an industry-approved vendorYesNo

The type of alarm that protects your business is:Bells Only (Audible) - sounds an external bell immediately on activation.Digital Communicator (Digicom) - remote signalling connected to an alarm company central station via a telephone line.Digital Dialler - remote signalling that can send a pre-recorded message to a specified location on activation.Dual Com - remote signalling that combines the use of telephone line and radio signalling.Dual Com Plus - as per Dual Com, however, this may also encompass wireless signalling technologies.PAKNET - remote signalling connected to an alarm company central station via radio signalling.Redcare (Classic) - remote signalling connected to an alarm company central station via a telephone line, constantly monitored by the exchange.Redcare GSM - as per REDCARE, however it uses a dual monitored signal path using the GSM wireless network.Other

Number of Employees

Employee Wage Roll

What is your estimated turnover for this year *

What is your estimated gross profit *

Indemnity Period (Months)1218243648

Property Owners Limit of Indemnity£2,000,000£5,000,000

Is following information is correct?

YesNo

1) The premises are not a Listed Building

1) Are the premises listedNot ListedGrade 1 Listed BuildingGrade 2 Listed BuildingGrade A Listed BuildingGrade B Listed BuildingGrade B2 Listed BuildingGrade C(s) Listed BuildingPreservation Order

2) Your premises will not be left unoccupied or unused for more than 45 consecutive days(excluding Covid-19 enforced closures)

YesNo

3) The heating is fixed heating

3) Please confirm the type of heating at the premisesNoneFire - OpenFixed HeaterHot AirOil HeaterPortable HeatersPressure Jet HeatersRadiant Panel HeaterRadiators Panel HeaterRadiators - Oil FilledStoveWaste Oil HeaterExtracted Sawdust fuelled heatingother

Please confirm the type of fixed heating - fuel typeBottled GasElectricityGasHeating OilLPGNatural GasParaffinSolid FuelWaste OilWoodother

4) The proposer, director or partner of the Trade or Business or its Subsidiary Companies has never personally or in any business capacity:

- been convictions of a criminal offences which are not spent under the Rehabilitation of Offenders Act or has any prosecutions pending

- been declared bankrupt or insolvent or been the subject of bankruptcy proceedings or insolvency proceedings

- had a proposal refused or declined - had an insurance cancelled - had a renewal refused - had special terms imposed

YesNo

5) There has been no losses or incidents giving rise to a claim in the last 5 years

YesNo

Please confirm number of claims012345More than 5

Claim 1 - date of loss

Please confirm type of claimPlease ConfirmFireTheftGlassPublic Liability - Slips Trips and FallsEmployers LiabilityImpactLoss of money (theft)Business interruption

Please confirm loss amount

Claim 2 - date of loss

Please confirm type of claimPlease ConfirmFireTheftGlassPublic Liability - Slips Trips and FallsEmployers LiabilityImpactLoss of money (theft)Business interruption

Please confirm loss amount

Claim 3 - date of loss

Please confirm type of claimPlease ConfirmFireTheftGlassPublic Liability - Slips Trips and FallsEmployers LiabilityImpactLoss of money (theft)Business interruption

Please confirm loss amount

Claim 4 - date of loss

Please confirm type of claimPlease ConfirmFireTheftGlassPublic Liability - Slips Trips and FallsEmployers LiabilityImpactLoss of money (theft)Business interruption

Please confirm loss amount

Claim 5 - date of loss

Please confirm type of claimPlease ConfirmFireTheftGlassPublic Liability - Slips Trips and FallsEmployers LiabilityImpactLoss of money (theft)Business interruption

Please confirm loss amount

6) The premises are not in an area with a history of flooding

YesNo

7) The property is of standard construction, the walls are built of brick, stone or concrete and the roof is slate, tile or concrete with 0% of flat roof

YesNo

WallAsbestosBrickBrick / Timber FrameConcreteFlintGlassMetalSlateStoneTileTimberOther

Roof constructionAsbestosConcretecorrugated IronFelt on TimberGlassMetalShingleSlateTileTimberWoodworkThatch - FibreThatch ReedOther

% of the roof which is a flat roof0%0% - 5%5% - 10%10% - 15%15% - 20%20% - 25%25% - 30%30% - 35%35% - 40%40% - 50%50% - 60%60% - 70%70% - 80%80% - 90%90% - 100%

8) The property and adjacent property have not suffered or shown any visible signs of damage from subsidence, landslip or ground heave

YesNo

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