Shop Insurance Form

Please fill in all fields

Acceptability Criteria

The property to be insured:

  • is in good repair and will be so maintained.
  • is of Standard Construction (constructed of brick, stone or concrete and roofed with slates, tiles, asphalt, metal or concrete)
  • must NOT have been previously flooded, be located in an area which has previously flooded or be particularly exposed to flood damage
  • must NEVER have shown signs of subsidence, heave or landslip, coastal or river erosion or be located in an area exposed to such damage

The proposer or any director, partner or Princial of the business:

  • must NEVER have been convicted of or charged with (but not yet tried for) any criminal offence, (other than a motoring offence)
  • must NEVER have been refused insurance, had special terms or conditions imposed, or had insurance cancelled or renewal refused
  • must NOT, in the past 5 years, have incurred any claims or suffered any losses for any of the perils or contingencies to which this insurance applies

Confirm acceptability criteria

Contact Details

Full name
Phone number
Full postal address

Business Details

Business name:
Business type
Address (if diferent from contact)
How long have you occupied the premises?

Building description:

  1. Does any part of the property have a flat roof?
  2. Are the walls built of brick, stone or concrete and the roof of slate, tile or concrete? If No please give details below.
I % Flat Roof:
I & II: Please give details:
Does anyone live on the premises?

Security at your premises.

  1. Are all external doors and if applicable, internal doors leading to common parts fitted with 5 lever mortice deadlocks?
  2. Are all ground floor windows and any other accessible windows protected by either grills or roller shutters or internal bars?
  3. If you have answered NO to either of the last two questions, please provide full details of the security applicable?
  4. Are the premises covered by their own CCTV?
  5. If YES give details of Area covered and how long they are recorded for?
  6. Are the premises protected by an intruder alarm system?
A door locks 5 lever mortice lever
B window locks:
C: Give full details
E :Please give detais
F intruder alarm:
Is work done away from premises?

Cover Required

*Buildings (incl. landlords fixtures & fittings & Tenants improvements)

Renewal / start date:
Stock in trade:

How & May We Contact You?

Prefered contact method:
Prefered contact day
Prefered contact time: