| Name |
* |
| Address |
|
| Daytime
Telephone No. |
* |
| e-mail
address |
* |
| Business
Description |
|
| Date
Established |
|
| Trading
as |
|
| Renewal
Date |
|
| Present
Insurers |
|
| Property
Damage |
|
| Property
Damage |
Yes
No
|
| Is cover
to include accidental damage? |
Yes
No
|
| Amount
of Buildings cover (€) |
|
| Amount
of Stock cover (€) |
|
| Amount
of machinery, fixture, fittings (€) |
|
| Business
Interruption |
|
| Business
Interruption |
Yes
No
|
| Gross
Profit to be Insured (€) |
|
| Money |
|
| Cover
for money required? |
Yes
No
|
| Goods
in Transit |
|
| Goods
in Transit required? |
Yes
No
|
| No.
of Vehicles |
|
| Sum insured
per vehicle (€) |
|
| Liability |
|
| Employer's
Liability |
Yes
No
|
| Wage
Roll (€) |
|
| Public/Product
Liability |
Yes
No
|
| Company
Turnover (€) |
|
