Insurance Renewal Form

About this form You have a statutory duty to make a fair presentation of risk to your insurers. The need for accuracy and honesty in presentation of facts cannot be overstated, To learn more about this duty see Presenting the Facts If you do not have all the information immediately to hand, please complete as much of the information as possible.

Declaration By Clicking “Send” you agree to be contacted by an FCA Authorised Advisor and confirm that you have read & agree with our Terms & Conditions and Privacy Policy. The Business Insurance Bureau is authorised and regulated by the Financial Conduct Authority (FCA) and our registration number is 307026. We are authorised to conduct General Insurance and this can be verified by contacting the Financial Conduct Authority (FCA) on 0845-606-1234 or www.fca.gov.uk/register.


Alterations and changes to policy’s are not instantly active, nor should be considered acted upon until the business has had the opportunity to contact the insurers regarding your policy to make them aware of the facts.

Policy Holder Name: 
Business Name:
Risk Address: 
Postcode: 
Telephone: 
Email: 
Employer Reference Number: 
Employer Name as registered with HMRC: 


Have there been any changes in ownership including Address, Business Activities, Occupation of Premises: 
Details of any alterations to construction, security or fire protections at the premises: 
Since the policy was last reviewed, please advise any changes to the sums insured under the following sections of cover:
Buildings: 
Contents: 
Stock: 


Please advise current figures for:
Turnover: 
Wage roll: 
Employee Count: 
Gross Profit: 


Do you Employ Delivery Drivers: YesNo
If so, are they?: EmployedSelf EmployedAgency


Do you employ Door Stewards: YesNo
If so, are they?: EmployedSelf EmployedAgency


If applicable, please provide the date(s) on which you’re cooking/frying range and ducting was last "deep cleaned" & serviced:

Can you confirm all Electrical systems in the premises are certified including PAT Testing:
YesNo


Details of any other material circumstances (e.g. criminal convictions, HSE prohibitions) we ought to know:

Details of any unreported incidents which could lead to a potential insurance claim:

Has any principal, Partner, Director or any senior management ever been sequestrated or bankrupt, or been in a business that has entered insolvency proceedings, liquidated or placed into administration: YesNo
Details of any additional cover you would like us to provide a quotation or information on: Business InterruptionBusiness TravelCommercial CombinedCommercial PropertyCybercrime & Commercial CrimeDirectors and OfficersEngineering InsuranceIncome ProtectionMarine CargoMotor FleetProduct Liability InsuranceProfessional indemnityPublic LiabilityTerrorism
The additional covers incorporated into my insurances, including Commercial Legal Expenses and Loss Assist, have to be renewed alongside my other business insurance renewals.
YesNo


I confirm by submission of this information I have consulted senior management and colleagues to present a Fair Presentation of Risk for this business:
Confirmed



Signed By: 
Your Position: 
Date Completed: