Contact Butchers Insurance

Name of Policyholder *

Risk Address including postcode *

Contact Number *

Your Email Address *

Please confirm Renewal / Inception date

Occupation *

Number of years trading *

What describes your location *

When was the Building built *

Please provide the number of flats

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 vendor

The type of alarm that protects your business is:

Number of Employees

Employee Wage Roll

What is your estimated turnover for this year *

What is your estimated gross profit *

Indemnity Period (Months)

Property Owners Limit of Indemnity

Is following information is correct?

YesNo

1) The premises are not a Listed Building

1) Are the premises listed

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 premises

Please confirm the type of fixed heating - fuel type

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 claims

Claim 1 - date of loss

Please confirm type of claim

Please confirm loss amount

Claim 2 - date of loss

Please confirm type of claim

Please confirm loss amount

Claim 3 - date of loss

Please confirm type of claim

Please confirm loss amount

Claim 4 - date of loss

Please confirm type of claim

Please confirm loss amount

Claim 5 - date of loss

Please confirm type of claim

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

Wall

Roof construction

% of the roof which is a flat roof

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

YesNo

Any additional information you would like to provide

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