Fact Find: (Individuals/Small Companies)

Cover available to: Permanent Residents of UK (except Eire) and Overseas Visitors temporarily working in the UK (except Eire)

Applicant Details

1st Applicant Title:
Forenames:
Surname:
Name of Act/Ltd. Company:

Date Of Birth:

Status:

Address

Address House No/Name:
Street:
Town:
City:
County:
Postcode:

Contact Details

Your Contact Details Daytime Phone:
Home Phone:
Mobile (Optional):
E-mail (Required):
Facsimile (Optional):

Full Details of activities to be insured:

Notes No. of years experience
(mm-yyyy):

Cover Required:

Public/Products Liability: (Only tick if required)

£2,000,000

£2,000,000 including heat

£5,000,000

£5,000,000 including heat

Employers Liability: (Only tick if required)

£10,000,000

Number of Employees:

All Risks (Insert sums insured if required)

Total Sum Insured

Collections (£):
Equipment (Excluding musical instruments) (£)

Musical Instruments (£):
Maximum value of one article (£):

Cover Required:

United Kingdom (ex Eire)

Worldwide

Overnight Cover. Ungaraged Vehicle?:

General Questions

Have you ever been refused insurance?:

Have you any previous or pending Criminal convictions (Not motoring offences)?:

Have you previously made an insurance claim In respect of the insurances requested above?:

Have you ever been declared bankrupt or have Any County Court Judgements against you or Pending?:

If you have answered “Yes” to any of these questions please provide us with full details:

How did you find Us?

How did you find Us?:

Submit your Fact Find

Please note that you are not requesting cover by submitting
this Fact Find merely request a premium indication,
Our response will follow in due course  (Office hours Monday to Friday 9am to 5pm)