Pub Insurance Proposal Form

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General details


Name and address of Pub or Bar (risk address including post code)	A value is required.
Please click here to add additional Pubs if more than one


Additional: Address of Pub 2






Additional: Address of Pub 3

Owners name (if sole trader) or Company name (if Limited Company)

Nature of business
Turnover in last financial year
Estimated turnover this financial year
Year business established at risk address
Number of employees (Approx)
Full time
Part time
Approximate total amount of employee wage bill (if known)


Is hot or cold food served in the Pub or Bar?	Yes No

	If Yes, please give details:

How many covers?
Self service or waiter service?
Does the kitchen have any deep-fat fryers with their own separate extracting systems?		Yes No

Is any live entertainment provided?

Yes No

	Please give a brief description of the type of live entertainment and how often held at the premises

Do you have a late night licence extension?		Yes No

Are there any of the following provided at the premises?
	Function rooms	Yes No

	Please provide brief details here:

Bouncy castles

Yes No

	Please provide brief details here:

Children's play areas

Yes No

	Please provide brief details here:

Discos

Yes No

	Please provide brief details here:

Dance floor

Yes No

	Please provide brief details here:

Door staff

Yes No

	Please provide brief details here:



When do you need cover to start/When is your renewal date?

Property damage


Do you require cover for damage to trade contents and/or buildings?	Yes No

	If Yes, please indicate level of cover required for (�):

	Buildings
	Machinery
	Wet stock
	Food stock
	Frozen food stock
	Fixtures & fittings
	Contents of flat

Business Interruption


Do you require cover for loss of profit due to interruptions to your business?	Yes No
If yes, please note the minimum cover is �500,000.


	Minimum cover	Cover required
If a higher amount is required, please enter the figure here	£500,000

Money and Personal Assault


Do you require cover for Loss of Money and/or Assault to you or your staff?	Yes No


	Please note the minimum cover as follows:	Minimum cover	Cover required

	Cash in transit or bank night safe	£3,000
	On premises during business hours	£3,000
	Out of hours in a locked safe	£1,500
	Out of hours not in a locked safe	£500
	In your home or home of employee	£500
	In custody of an approved security company	£20,000
	Cheques (crossed), credit card vouchers, VAT purchase invoices	£250,000
	Personal assault to you or staff	£10,000

Glass


Do you require cover for breakage or damage to glass in doors or windows, mirrors or external signs?	Yes No

Employers's Liability


A statutory requirement under UK legislation, this covers legal liability for injury to employees up to £10,000,000.	Yes No


Please enter here if the sum required is greater than £10,000,000.

Public Liability


Do you require cover for accidental injury to the public or damage to their property due to your or your employees negligence?	Yes No


Please enter here if the sum required is greater than £2,000,000.

Products Liability


Do you require cover for accidental injury to the public or damage to their property for products sold, supplied, serviced, repaired or hired by you?	Yes No


Please enter here if the sum required is greater than £2,000,000.

Pub Insurance Proposal Form

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All risks


Do you wish to select a wider cover for your business machines to provide cover for any accidental loss or damage?	Yes No


	Please choose the territorial limits within which this cover is to apply:

	Premises
	UK
	Europe
	Worldwide

Book debts


Do you wish to insure against outstanding book debts you are unable to trace due to damage to accounting records?	Yes No


Please enter here if the sum required is greater than £25,000.

Goods in transit


Do you wish to cover business goods whilst in transit in your vehicles or with other carriers in GB?	Yes No


Please enter here if the sum required is greater than £2,500.

Terrorism


Do you wish to extend your cover to include damage caused by acts of terrorism to the property in the areas to be insured under the headings Property Damage and All Risks above?	Yes No

Questions about your premises and risk management


Is the premises constructed of brick, stone, concrete or steel and roofed with tile, slate or concrete?	Yes No

Please give details here

Are the walls which divide the premises from other users of the building and adjoining
premises built of brick stone or concrete?

Yes No

Please give details here


Is the premises in good condition and well maintained?	Yes No

Please give details here


Is the premises protected by a burglar alarm?	Yes No


Please state whether PackNet, DigiCom, RedCare, DualCom, ABC, Police Direct, Bells Only or Other.

If Other, please give details here

Does the premises benefit from recorded CCTV?

Yes No

	Please give a brief description of the areas covered by CCTV


Are any parts of the building containing the premises to be insured vacant or unused?	Yes No

Please give details here


Are you the sole business occupant of the building containing the premises for which insurance is sought?	Yes No

Please give details here


Is any part of the electrical wiring system at the premises greater than 40 years old?	Yes No


Are Gas Safety Inspections carried out on all gas appliances at least annually?	Yes No


Does the premises have suitable fire extinguishers correctly sited and inspected annually?	Yes No

Claims experience


Have you or your business suffered any accidents or losses, whether covered by insurance or not, or had any claims made against you during the past 5 years?	Yes No

Please give details here

	Brief details of claim(s)	Date	Approx amount of claim

Other material facts

Please be aware that it is essential that all material facts be disclosed at inception or during currency of the insurance. A material fact is information that may affect the insurers decision to provide cover, such as previous losses, convictions, vehicle modifications, occupancy of property, etc. If you are in any doubt please give further details regarding what may be a material fact here.

Contact details

So that we may readily discuss or clarify any aspects of the proposal form with you, please supply your relevant contact details below:

	Your name
	Daytime telephone number
	Mobile telephone number
	email address
	Correspondence address (if different to risk address above)

Declaration


I/We declare that: i) to the best of my/our knowledge and belief, the answers given are true and that all material facts have been disclosed; ii) this proposal and declaration shall form the basis of the contract between me/us and the Underwriters and when I/we accept a policy on the standard form issued by the Underwriters will be bound by the terms and conditions thereof;