Proposers Name             


Correspondance Address
Post Code

Risk Address 
Post Code
Contact Name   email
Phone Mobile Fax
Full Occupation
Date Established Do you reside on premises? Yes No Home Contents£
Details of any other occupants sharing the premises
 
Hours of Business
Do you serve Food/Drink for consumption on premises (If so, seating capacity?)
Construction of Walls  Floors   Roof
Claims in the last five years (Date, description, cost, finalised?)
 
Fire Extinguisher?
Yes No Fire Alarm?       Yes No    Linked/ Monitored?      Yes No
Security: CCTV?
Yes No Intruder Alarm?       Yes No    Linked/ Monitored? Yes No
In Store ATM?
Yes No Roller Shutters?       Yes No    Safety Policy?      Yes No
Existing Insurer and Premium  Date of cover
Property Cover (Material Damage All Risks Including Theft & Glass)
1. Buildings        £ Annual Rent (if applicable) £
2. Fixtures, Fittings & All Other Contents       £ Employers Liability - Limit of Indemnity £10 Million
3. Tenants Improvements £ Annual Wages - Clerical Staff £
4. Garage Canopy £ Annual Wages - Shop Assistants £
5. Fuel Pumps £ Annual Wages - Property Repairs (inlude provision for temporary direct labour) £
6. Car Wash  £ Total Number of Employees   
7. Petrol/Diesel in underground tanks £ Public & Products Liability - Limit of Indemnity £5 Million
8. Cigarettes & Tobacco £ Annual Turnover £
9. Wine & Spirits £ Cash Cover
10. General Stock £ Cash in transit to/from Bank (Automatically £15,000, otherwise specify) £
11. Frozen Foods (Automatically £18,000, otherwise specify) £ Cash on premises during business hours (Automatically £15,000, otherwise specify) £
Business Interruption/Loss of Profits Cover (Based upon 12 month period - if longer required, specify period Cash out of hours in safe (Automatically £15,000, otherwise specify) £
Details of Safe
Gross Profit (Automatically total 3 times sum of items 2 to 10 above, otherwise specify) £
 
       
Personal Accident Cover (Optional Extra)
(24 Hour cover incl. continental scale)
Benefit
Death & Capital Benefits
Temporary Total Disablement
Medical Expenses
Premium 		Option (a)
£75,000
£350 per week
£1,750
£35 per person

Option (b)
£175,000
£450 per week
£3,500
£50 per person
Fill in the numbers of staff in each category and tick which options you require
No. of Directors/Principals    Option (a) Option (b)
No. of Managers                    Option (a) Option (b)
No. of other employees          Option (a) Option (b)
Additional Information
Date  
 

 

 

 

 

 

 

 

 

 

      

 

  Our dedicated team will

          answer any of your queries:

 

The Insurance Shop,
84 North Strand Road,
Fairview, Dublin 3, ireland.

                 

                 Telephone:  08001970028
                 Fax:               08001970027

                 Email:           gerry@tis.ie or
                                        tony@tis.ie