Proposer Details
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| Proposer Name: * |
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| Company Name: * |
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Date of Birth
Please Select the Day, Month & Year you were born |
| Day: * |
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| Month: * |
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| Year: * |
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| Address: * |
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| Postcode: * |
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| Type of Business: * |
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| Daytime Telephone Number: * |
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| Website Address: |
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| Email: * |
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| What Directed You To Our Website?: |
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| Company Status: * |
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| Number of Employees * |
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| Number of years experience: * |
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| Details of any criminal convictions for you or any other principal or director of the company |
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| Have you or any principal or director of the company had any policy cancelled, refused insurance or had terms imposed by any insurer or been declared bankrupt? |
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| Details of claim history: |
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| Nature of work undertaken: |
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| Do you have visitors to the home in connection with the business, if so please provide details of how many and how frequent? |
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| Do you conduct business away from the premises - please provide details? |
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| Estimated annual turnover: * |
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| Does your business include distribution or retailing of any goods? * |
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Your Premises |
| Type of property: * |
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| What is the construction of your property? * |
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| What year was the property built? * |
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| Please confirm what type of security is fitted to doors and windows: * |
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| Does the property have an intruder alarm? * |
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| If yes, is it NACOSS approved? |
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| Is the home permanently occupied soley by you and your family? * |
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| has the property ever suffered from a history of flooding or subsidence or in an area likely to be affected by flood or subsidence? * |
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| Where at the property is the business conducted? * |
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Cover Options |
| Public Liability * |
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| Employers Liability * |
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| If yes, please provide details of your Employers Reference Number (ERN): |
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| Business Contents: * |
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| If yes, please confirm overall value, highest value of any one item and if cover is required away from the premises: |
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| Plant or Machinery: * |
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| If yes, is this own plant or hired plant, total value and single article limit: |
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| Stock Cover: * |
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| If yes, please confirm what type and value of stock kept: |
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| Business Interruption Cover: * |
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| Computer Breakdown Cover: * |
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| Goods in Transit: * |
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| If yes, how much cover and how many vehicles does cover need to apply to? |
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| Buildings Cover: * |
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| If yes, please provide details of sums insured: |
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| Household Contents: * |
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| If yes, please provide details of sums insured: |
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| Personal Possessions: * |
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| If yes, please provide details of sums insured: |
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| Please provide details of any other cover required: |
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Terms & Conditions
- I understand Ryan Insurance Group use a select panel of insurers for this type of business
- My quotation will be valid until the end of the current month
- I am obliged to provide all material facts that may affect the rating or acceptance of the policy, as failure to do so could invalidate my insurance cover
- Ryan Insurance Group is obliged by law to give me the opportunity to hear how they give advice, deal with compensation and handle complaints. This information is contained within their terms of business agreement (attached).
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Agreement |
| I have read and agree to the terms and conditions above: * |
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