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Wine Bar Insurance

Email*

Telephone*

Mobile

Cover Required From

Renewal Premium

Title

Full Name*

Type of company

Primary Trade

Risk Postcode

Building No/ Name

Years Trading

Experience :

Does the Premises have a Timber Roof?

Does the Proposer Live on the Premises?

Premises Alarm Bell Only?

Premises Alarm a Digicom?

Premises protected by CCTV?

Premises Alarm is RedCare?

Premises Alarm is RedCare GSM/ DualCom?

Premises have an ATM machine?

Proposer Require Subsidence?

Propposer Require Accidental Damage?

Proposer began trading when?

Claims/ Losses in the last 5 years?

Please provide details for all Claims or Losses: Date, Reason and Loss Amount