Select All Fire & other specified perils Business Interruption Burglary Money Glass Liability Transit Electronic Computer Breakdown Machinery Breakdown General Property Tax Audit Employee Fraud Motor Vehicles Domestic/Residential Thank you for your interest, now tell us who this enquiry is for?For us to provide the best response to your inquiry please complete the following*This inquiry is for an existing business with current insuranceThis inquiry is for an existing business without insuranceThis inquiry is for a new business Let's get started with your personal information?Name* First Last Email* Telephone*Address* Street Address Tell us about your BusinessName of the business*Describe your businessWhat is the required start date of the insurance? Date Format: DD slash MM slash YYYY Is your business premise address different to your contact address?*YesNoBusiness Address* Street Address Does your business operate from multiple sites?*YesNo Can you give more information about the building where your business is operated?Age of building in yearsWhat is the roof made of?*TileSteelWhat are the walls made of?*BrickworkConcreteSteel on steelSteel on woodWhat are the floors made of?TimberConcreteWhat type of alarm system is installed?*MonitoredLocalNone Tell about Fire & other specified perilsSum InsuredBuilding $Stock $Contents $Others (please specify}Description$ Business InterruptionIndemnity Period6 months12 monthsSum InsuredGross Profit $Increased Working Cost $Wages $Rent $Other $Other DescriptionTotal $ BurglarySum InsuredContents $Stock $Tobacco $Combined contents / stock $Other $Other Description MoneySum InsuredIn Transit $On Premises $On premises outside $Business hours $In Safe $Personal custody $Other $Other Description GlassSum InsuredInternal or External Internal - Replacement Value External - Replacement ValueSigns $ LiabilitySum InsuredPayout$5 Million$10 Million$20 MillionTurnover $Wages Paid $Staff Numbers $Are you the property owner?NoYesDescribe tenant's businessDo you import products?NoYesProduct 1Country of origin 1Product 2Country of origin 2Country of origin 3Product 3 TransitOwn VehiclesMaximum Value per load $Annualised Total Carry $Number of Vehicles #Professional CarriersMaximum Value per load $Annualised Total Carry $ Electronic Computer BreakdownDescribe equipment you wish to insureSum Insured $ Machinery BreakdownSum InsuredRefrigeratorAmount of unitsUnits $Air ConditionerAmount of unitsUnits $OtherAmount of unitsUnits $ General PropertyDescribe equipment you wish to insure 'away from your business' (e.g. laptop computers)Sum Insured Tax AuditSum Insured $ Employee FraudSum Insured $ Motor VehiclesMake and modelYearRegistration NumberMain DriverDate Of Birth Date Format: DD slash MM slash YYYY The vehicle is garagedNoYesGarage postcodeNCB rating or rating numberUse Business PrivateUnder FinanceNoYesPrior to the Insurer accepting any risk they will require information about any claims over the past 5 years where the claims relate to the type of insurances you wish to take out. Please describe those claims: How would you prefer us to contact you?* Phone EmailEmail A Copy To Me Tick for yesEmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.