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Thursday, 23 May 2013
Commercial Property Quote
  1. Full Name(*)
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  2. Occupation
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  3. Place of Employment
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  4. Street Address(*)
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  5. PO Box
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  6. Settlement, Island(*)
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  7. Email(*)
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  8. Telephone(*)
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  9. Work Phone
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  10. Fax
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  11.  
  1. Previously Insured?(*)
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  2. Have you had any insurance refused or subjected to special terms?(*)
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  3. Have you had any losses during the past 3 years?(*)
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  4. Have you been convicted of, or have been charged with but not yet tried for, arson or any offence involving dishonesty of any kind such as fraud, robbery, theft, or handling stolen goods?(*)
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  5. If you have answered “YES” to any of these questions, please provide full details below.
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  6.  
  1. Business Address
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  2. Distance From the Sea
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  3. Business or Trade
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  4. How Long in Operation?
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  5. Number of Employees
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  6. Building Construction
  7. Walls
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  8. Roof
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  9. Number of Stories
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  10. Are the buildings




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  11. Do you occupy the whole premises?
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  12. If not, what other businesses or trades are carried on?
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  13.  
  1. Period of Insurance From
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  2. Period of Insurance To
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  3. Sums Insured
  4. BUILDINGS - Including Landlords Fixtures and Fittings therein and thereon
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  5. Machinery - Machinery, Plant, and All Other Contents therein and thereon, the property of the Insured or held by them in trust for which they are responsible, excluding (a) Landlords Fittings and Fixtures, (b) Stock and Materials in Trade, (c) Property more specifically insured, (d) Sea Walls, Canal Walls, Docks, Satellite Equipment and T.V. Antennae.
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  6. Miscellaneous (List Below)
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  8. Other Coverage Required
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  9. Total
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  10.  
  1. I declare to the best of my knowledge and belief the information on this form is true in every respect. I also declare that if anything on this form was written by another person, he or she acted as my agent for this purpose. I agree to keep the property in a good state of repair during the currency of this Insurance. I agree that this proposal and declaration will be the basis of the contract between me and the Insurer.
  2. By selecting the submit button you agree to this statement.
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