Name:

E-mail address:

Trading Name:

Postcode:

Daytime Telephone No:

Renewal Date:

Type Of Restaurant:

Do You Have a Deep Fat Fryer? Please Choose Yes No

Do You Have an Alarm? (please state model)

Contents Sums Insured:

Tenants' Improvements:

Fixtures and Fittings:

Stock:

Frozen Foods:

Wines and Spirits:

Tobacco:

Building Sum Insured:

Accidental Damage? Please Choose Yes No

Any Previous Subsidence? Please Choose Yes No

Year Built:

Please list details of any previous claims: