Pre-renewal-Questionnaire

Basic Insurance Information

Here you can fill in the basic information required process your renewal, If you do not have an Employers reference number or have not yet registered with HMRC leave these fields blank.


Policy Holder Name:

Business Name:

Risk Address:

Postcode:

Telephone:

Email:

Employer Reference Number:

Employer Name as registered with HMRC:


Business Activities

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:

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



Sums Insured

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:





Basic Insurance Information

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:

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: