Name
Trading Title
Address
		Postcode
Telephone		E-Mail Address
Business	Fish and Chip Shop Fish and Chip Restaurant Unlicensed Fish and Chip Shop Restaurant Licensed Other Specify Below
Unlisted Business
Who else occupies the property?		-Choose- Shop - Proposer lives on premises Shop- Employee Lives on Premises Shop - Manager Lives on Premises Lock up Shop Lock up shop with dwelling upstairs
Date Business Established
Premises Details
-Walls- Brick Brick/Steel Steel Wood Concrete Other -Roof- Slate Steel Concrete Timber/Felt Other -Floors- Concrete Stone Wood Other ATM/Cash Machine No ATM Cash Machine Yes-inside premises Yes-outside premises
-Heating- Gas CH Electric Oil Portable Heaters None -Electrics Checked- Less than 12 months Less than 3 years Less than 5 Years Other Shop Front Protection Roller Shutters External Grilles Internal Grilles None
Accessible Window Protection Grilles and Window Locks Window Locks Internal Grilles None -Intruder Alarm- NACOSS Approved BT Redcare SSAIB Approved BT Redcare NACOSS Approved Digital Commmunicator SSAIB Approved Digital Communicator Bells Only Alarm Other Alarm None
Deep Fat Frying - Select Free Standing Range Table Top Basket None Age of Range - Select Not Applicable Less than 1 Year Less than 2 years Less Than 3 Years Less than 4 Years Less than 5 Years Over 5 Years Over 20 Years No Range
Sums Insured
Buildings		£ full rebuilding cost.
Landlords Fixtures and Fittings		£
Tenants Improvements		£
Stock excluding items below		£
Wines and Spirits		£
Cigarettes and Tobacco		£
Shop Fronts and Fascia		£includes neon signs
All Other Contents		£business equipment
Electronic Business Machines		£Tills, computers etc
Business Interruption		£12 months Gross Profit
Loss of Money	Cash in Transit £Cash in Safe £
Frozen Foods Cover		Choose Yes No	£
Goods in Transit		Choose Yes No	Please Select £1,000 £2,500 £5,000
Claims in the Last Three Years		Yes No
Claims details of any
Please provide any additional information that you feel may be useful or important to the understanding of your risk, or detail any additional requirements, you may have.