Risk Questionnaire for Shops and Retail Business Insurance

Name of the person providing information within this form:

Position held within the business:

Email:

Phone:

How many Directors and/or Partners the Proposer have in total?

1) Full name / Date of Birth / Position within the business

2) Full name / Date of Birth / Position within the business

3) Full name / Date of Birth / Position within the business

4) Full name / Date of Birth / Position within the business

Please choose from the following options below that apply to any Owner, Director or Partner:

had any convictions or criminal offences which are not spent under the Rehabilitation of Offenders Act or have any prosecutions pending
have been the owner or director of, or partner in, any business, company or partnership had a county court judgment awarded against them
have been declared bankrupt or insolvent or been the subject of bankruptcy proceeding or insolvency proceeding
have been disqualified from holding company directorship
have been the subject of a recovery action by Customs and Excise or the Inland Revenue
had CCJ's and Sheriff Court Decrees
Not applicable

Please choose from the following options below that apply to any Owner, Director or Partner:

had an insurance proposal refused or declined
had an insurance cancelled by an insurer
had been asked to take extra precautions by insurers
had special terms imposed
Not applicable

Business or Partnership Name:

Trading name:

Status of entity:

Company registration number:

Are you VAT registered?

VAT number:

Business description:

Date business was established:

Does the business have any employees?

Employer PAYE No:

Total number of employees?

Are all employees (inc. LOSC, trainees, apprentices) paid below PAYE threshold?

What is the estimated Wageroll for the next twelve months?

What is the estimated Turnover for the next twelve months?

Is there any percentage of turnover to be derived from the second hand goods? If yes, please provide the percentage below:

Premises address: (Please provide: Property Name, Building Number, Street name, Town & Post code)

Business hours:

Would you like to have a correspondence address different from the business premises?

Please provide correspondence address (Property Name, Building Number, Street name, Town & Post code):

Does the business own the premises?

Please provide a name of the owner registered on the Land Registry Title Deeds?

What type of the building is the business premises?

Commercial building
Industrial building
Domestic building
Mixed
Other

Primary building usage?

Secondary building usage?

Is the building listed?

Please provide details:

Year the property was built?

Date of purchase:

Please select if any following statements apply to the premises:

The property is not self contained with its own means of access
The proposer is not the sole occupant (if other than offices or private dwellings)
The property is closed for more than 3 consecutive months
The property is unoccupied, or has not been used in the last 30 days
Not applicable

Please select if any following statements apply to the premises:

The property is in area with history of flooding
The property has walls or roofs constructed of composite panels
The property has walls or roofs containing combustible linings
The property is erected on made up ground or has been underpinned
The property is surrounded by 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 unduly exposed to storms or high winds
The property is close to mines/underground workings
The property is close to cliffs, embankments, railway cuttings, tunnels, quarries or other excavations
The property is close to vibrations from major roads/railways
The property has visible signs of cracks
Not applicable

Total number of stories in the building?

How many stories are being used by the business?

Is any of the stories of wooden construction? If yes, how many stories?

Are the walls of the building constructed from:

Standard, one type of material
More than one type of materials

Please select the walls material from the options provided below:

Please specify what materials and describe percentage of each material used:

Does the building have a roof constructed from:

Standard, one type of material
More than one type of materials

Please select the roofing material from the options provided below:

Please specify what materials and describe percentage of each material used:

Is there an area of roofing flat?

Please state the approximate percentage of the roof being flat?

Is the premises in a good state of repair and free from damage?

Please describe the materials used for floors, staircases and internal partitions:

What type of heating is currently installed in the property?

Is there ATM located on the premises?

Please select the Risk Management Features that are currently active for this property:

Intruder Alarm
Fire Alarm
Fire Blankets
Fire extinguishers
Smoke detectors
Sprinklers
Regular Gas Inspection
Regular Electrical inspection
No safety features in place

Is the intruder alarm maintained by accredited company?

What type of signalling your alarm has?

Redcare
Digicom
Bells only
Other

Is the alarm maintained by accredited company for the alarm? Please provide details:

Is the alarm connected to the Police response?

Are your sprinklers maintained by Loss Prevention Certification Board approved company?

Sprinklers accreditation details:

What is your method of locking you exit door?

Please specify type of door locks

Please specify type of window locks

Please select other Risk Management Features are currently active for this property:

Private CCTV
Other monitored CCTV
Access Control
Shutters
Window bars
Guard dogs
Security Patrols
None

Do you have 30 days of more recording facilities on the private CCTV?

What is the estimated total value of the building? (Including Fixed Glass, Landlords Fixtures/Fitting)

What is the estimated value of the Business Fixtures and Fittings?

What is the estimated total value of the Electrical Equipment?

What is the estimated value of the Business Stock?

What is the estimated value of the Business Frozen Stock?

Would you like to protect your business Gross Profit in case of unexpected interruption to the business?

Please provide Gross Profit figures you would like to cover?

Preferred Indemnity Period:

12 months
24 months
36 months

Do you require to cover Money in Safe, Strongroom in the premises or in transit?

What is the Safe Make? / Model ?/ Description /? How is it secured?

Sum 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?

Have you had any losses or incidents giving rise to a claim in the last 5 years?

Claim history within the last 5 years:

Business Insurance renewal date:

Current or previous insurer:

Any addition information, would you like us to know?

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Risk questionnaire

for Shops & Other Retail Business

Please complete the form below to provide information about your business,
so we can assess your business risk and offer you comprehensive insurance quotes

Risk questionnaire

for Shops & Other Retail Business

Please complete the form below to provide information about your business, so we can assess your business risk and offer you comprehensive insurance quotes

Please complete the form below to provide information about your business,
so we can assess your business risk and offer you comprehensive insurance quotes