Business quote form -M-



Welcome to Emsons Business Insurance Quotation Form

Please note this form is for submitting details of your insurance risk to us. It does not in turn provide you with any automatic quotation or any cover. Any quotation that we subsequently offer on the basis of information that you have supplied will be confirmed to you by post or telephone. NO COVER will be in force unless we notify you. We may require additional information from you in order to prepare a quotation in which case you will be notified in writing, by email or post. Any quotation request you have submitted will be verified with you prior to any contract coming into force. Any policy that this quotation form may apply to is written under UK Jurisdiction.

Please complete the sections for which you require cover
There is a submit button at the end of the form to mail it to us
You will automatically be sent a copy of the form by e-mail, but if you wish to print it before sending, please press CTRL + P before submitting the form
Some business insurance needs will require individual and bespoke quotations - please telephone 01883 620720 if you have any questions.
Wherever you see this means that there is further information to view from our technical archive.
For each section of the form where no cover is required can you please state NO by selecting the relevant radio button at the start of that section.

Section - General Details

Trading Name
Address

Postcode
Please describe your business activities :

Renewal Date?
Any quotation submitted to Emsons will be verified with the Client before any cover is granted or any liability to pay any premium is incurred.

Section 1 - Buildings Insurance

Do you require buildings Insurance ?	YesNo

Please state the re-building cost of your property
Is the property in a good state of repair	YesNo

Please state the approximate year that the building was constructed ?
Is the building constructed of bricks with a tiled / slate roof ?	YesNo If not, please give details
Is subsidence cover required for the property ?	YesNo

What are any adjoining / neighbouring buildings occupied as ?
What will / is the building used for ?

Section 2 - Contents Insurance

Do you require contents insurance ?	YesNo

Do you own the freehold of the building that you are occupying ?	YesNo

Do you wish to insure any improvements you have made to the property ?	YesNo If so, please state their value
What is the value of the following items that you may wish to insure, if none, please state "0" on the form :
Fixtures and Fittings
Contents
Stock in Trade
Does your business involve the handling of any high risk or hazardous items or chemicals ?	YesNo If so, please give details

Do you require any cover for glass or signs that may be fitted to the premises ?	YesNo


Section 3 - Business Interruption

This section provides cover for the gross profit loss, or the increased cost of working, that may occur to your business as a consequence of a loss occurring under the contents or buildings sections of your policy.
Do you require business interruption insurance ?	YesNo

Please state your estimated gross annual profit for the forthcoming year
Over what period do you wish the claim to be paid ?	12 months24 months36 months


Section 4 - Employer�s Liability

It is mandatory for any person employing people in the UK to have employer�s liability cover
Do you require employer�s liability cover ?	YesNo

(note : the standard indemnity limit provided for this insurance is �10,000,000)
Please state your total annual wage roll, split as you feel appropriate between the following classifications :
Clerical and Managerial
Manual (work on premises)
Manual (work away from premises)
Bonafide sub-contractors (these persons will work to their own method statement and / or provide their own materials)

Section 5 - Public Liability

Do you require public and product liability cover ?	YesNo

What indemnity limit would you like a quotation for ?	�1,000,000�2,000,000�5,000,000Other

Please state your estimated annual turnover for the forthcoming 12 months
Is any part of your turnover derived from sales to the US or Canada ?	YesNo


Section 6 - Money Cover

Do you require cover for money ?	YesNo

Please state the sums insured that you require cover for, in the following instances :
Maximum sum when business is open
Maximum sum in transit
Maximum sum when closed for business and confined to a locked safe

Section 7 - Goods In Transit

Do you require cover for Goods in Transit ?	YesNo

What is the sum insured per consignment you require a quotation for ?
What vehicles do you use for the transportation of goods, if any? Please state what type of vehicles, and how many of each type you use


Section 8 - Additional Items

If you have any other commercial insurance requirements that you would like to be quoted for either separately or as part of this quote, please detail below :

Due to the relative complexity of some commercial insurance quotations, we may require some further information from you.
Please confirm below the most appropriate telephone number or e-mail address to contact you on


You will be forwarded a copy of this form by e-mail. Please enter your address below
E-mail address

IMPORTANT : You must have read and accepted the terms and conditions of the Declaration that accompanies this proposal - click here to view the terms - CLICK

Have you read and understood the terms of the Declaration?	Yes No

IMPORTANT : You must have read and accepted the terms and conditions of the Data Protection clause that accompanies this proposal - click here to view the terms - CLICK


Have you read and understood the terms of the Declaration?	Yes No

Upon receipt of your e-mail a response will be given within 1 working day at the most.