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Risk questionnaire for Offices
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Name of the person providing information within this form:
Position held within the business:
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Email:
Phone:
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How many Directors and/or Partners the business have in total?
1
2
3
4
1) Full name / Date of Birth / Position within the company
2) Full name / Date of Birth / Position within the company
3) Full name / Date of Birth / Position within the company
4) Full name / Date of Birth / Position within the company
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Select any of the following that apply to your business or any Director or Partner:
had a proposal refused or declined
had an insurance cancelled
had a renewal refused
had special terms imposed
been the subject of a recovery action by Customs and Excise or the Inland Revenue
been declared bankrupt or insolvent or been the subject of bankruptcy proceeding or insolvency proceeding
None
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Select any of the following that apply to your business or any Director or Partner:
been the owner or director, or partner in any business, company or partnership had a CCJ awarded against them
been disqualified from holding company directorship
been served with prohibition or improvement order under health and safety regulation
had any convictions or criminal offences which are not spent under the Rehabilitation of Offenders Act or have any prosecutions pending
Have CCJ's and Sheriff Court Decrees
Not applicable
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Business Name:
Trading name:
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Status of entity:
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Limited
Partnership
Private
Public Limited
Sole Proprietor
Religious Organisation
Charity
Association
Club
Community Group
Community Interest Company
Voluntary Organisation
Incorporated
Limited Liability Partnership
Local Authority
Public sector
Self Employed
Society
Trade Union
Trust
Company registration number:
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Business description:
Date business established:
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Turnover (next twelve months) (£)
Do you have any employees?
Yes
No
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Wageroll (next twelve months) (£)
Total number of employees?
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Employer PAYE No
Are all employees (inc. LOSC, trainees, apprentices) paid below PAYE threshold?
Yes
No
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Premises address:
Would you like to add a correspondence address?
Yes
No, use the premises address
Correspondence address:
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Property type:
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Are you the property owner?
Yes
No
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Name of the person holding the ownership on the Land Registry Title Deeds?
Date of purchase:
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Is the property listed?
Yes
No
Please specify:
Year the property was built:
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Please select if any following options below are applicable to the premises:
The business is not self contained with its own means of access
The property is closed for more than 3 consecutive months
The property is unoccupied, or has not been used in the last 30 days
The premises is in area with history of flooding
Not applicable
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Please select if any following options below are applicable to the premises:
The property is unduly exposed to storms or high winds
The property is erected on made up ground or has been underpinned
The property is close to mines/underground workings
The property has visible signs of cracks
Not applicable
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Please select if any following options below are applicable to the premises:
There are trees or shrubs, which are more than 5 meters in height and within 10 meters of the property
The property or adjacent property has suffered from, or shows any visible signs of damage from subsidence, landslip or ground heave
The property is close to cliffs, embankments, railway cuttings, tunnels, quarries or other excavations
The property is close to vibrations from major roads/railways
Not applicable
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Are the walls of the building constructed from:
Standard, one type of material
More than one type of material
Please select the walls material of the building from the options provided below:
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Asbestos
Brick
Brick/Timber Frame
Cob
Concrete
Corrugated iron
Fibreglass
Flint
Metal
Plastic
Prefabricated building - Combustible Materials
Prefabricated building - Non-combustible Materials
Slate
Stone
Tile
Timber
Please specify what materials and describe percentage of each material used:
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Does the building have a roof constructed from:
Standard, one type of material
More than one type of material
Please select the roofing material of the building from the options provided below:
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Tile
Asbestos
Slate
Asphalt
Concrete
Corrugated iron
Felt on timber
Fiberglass
Glass
Metal
Plastic
Shingle
Thatch - Fibre
Thatch - Reed
Timber
Woodwork
If, yes please specify what materials and describe percentage of each material used
Is there an area of flat roofing?
Yes
No
Please state the approximate percentage of the roof being flat:
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Total number of stories
Is the premises in a good state of repair and free from damage?
Yes
No
Describe the materials used for floors, staircases and internal partitions.
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Is an ATM located on the premises?
Yes
No
Please select relevant option below to describe area of your location
Predominately residential
Commercial
Industrial
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Please select all the Risk Management Features that are currently active for this property:
Intruder Alarm
Private CCTV with 30 days recording facilities
Town Centre / Local Authority CCTV
Access Control
Shutters
Window bars
Security patrols
Guard dog
Smoke detectors
Fire Alarm
Fire Blankets
Fire extinguishers
Sprinklers
Electrical installation inspected regularly
Electrical appliances inspected regularly
Central heating inspected regularly
Computer record back-up & off-site storage
Maintenance Programs in Force
Business Continuity Plan
None
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What's the name of the alarm?
Is the intruder alarm maintained by accredited company?
Yes
No
The name of contracted accredited company for the alarm:
What type of signalling your alarm has?
Redcare
Digicom
Bells only
Other
Is the alarm connected to the Police response?
Are your sprinklers maintained by Loss Prevention Certification Board approved company?
Yes
No
Sprinklers accreditation details:
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Please select the type of heating of the property:
Gas Central Heating
Hot Air
Portable Heaters
Radiators - Oil filled
Night Storage Heater
Electric Central heating
Fire - open
Fire - other
Oil Heater
Pressure Jet Heater
Radiant Panel Heater
Stove
Underfloor heating
Fixed Heaters
Wood burner
Other
No heating
None
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What is your method of locking you exit door?
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Please specify type of door locks
Please specify type of window locks
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What is the estimated total value of the building? (Including fixed glass, landlords fixtures/fitting)
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What is the estimated value of the business fixture and fittings?
What is the estimated total value of the Electrical Equipment?
What is the estimated total value of the Stock and Material in Trade (Including frozen stock, if applicable)?
What is the estimated total value of all other contents (Including fixtures & fittings, machinery, plant, tenants improvements)
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BUSINESS INTERRUPTION COVER
Would you like to consider Business Interrruption cover?
Yes
No
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Estimated Gross Profit for the next 12 months? (£)
Preferred Indemnity Period:
6 months
12 months
24 months
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Would you like to cover Money in Safe or Strongroom in the Premises?
Yes
No
What is the Safe Make? / Model ?/ Description ?/ How is it secured?
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Sum of money required to be insured contained in a locked safe
Sum required to be insured, which are not in a locked safe
Sum required to be insured in transit in the custody of a security company
Sum required to be insured in transit by Proposer or Employee
Sum required to be insured on premises during business hours
Sum required to be insured on premises outside business hours
What's the amount of annual cash carrying by you?
What's the amount of annual cash carrying by security company?
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Have there been losses or incidents giving rise to a claim in the last 5 years
Yes
No
Claim history within the last 5 years (If applicable)
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Insurance renewal date:
Current or previous insurer:
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Any addition information?
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