Commercial

Please complete the form below as accurately as possible and submit to us for a quote.

Required fields are in bold

     
1.

Name of insured

     
2.

Contact name/Intermediary

     
3.

Correspondence address

     
 

Postcode

     
4.

Telephone number

     
5.

Fax number

     
6.

Email

     
7.

Risk Address

     
 

Postcode

     
8.

Occupied as

     
9.

Type of construction of building and roof?

     
10.

Age of property?

     
11.

Is the property listed?
(NB we are unable to quote for Grade 1 and 2* properties. Grade 2 or Scottish equivalent is accepted)

Yes No

     
12.

Last 3 years' claims history (if none please state so)

     
13.

Has the property ever suffered from subsidence, heave, landslip or flood?

Yes No

     
14.

Rebuild cost of property (declared value)

     
15.

Annual rent figure


No. of months 12 24 36

     
16.

Landlord's contents (residential
portions only) sum insured

     
17.

Existing Insurers

     
18.

Insurance Renewal Date

     
19.

Current Premium (leave blank if this is your first policy)

     
20.

Terrorism quote required ?

Yes No

   


T: 01303-241170 | E:info@stephenlower.co.uk | F: 01303-850653