Welcome to Waveney Insurance Brokers

Doctors Surgery Insurance

Complete the short form below to get a quotation or call 01473 269443

Renewal Details      
Renewal Date   Renewal Premium  
Customer Details      
Clients Name Trading Name
Telephone Number   Email  
Building Name/Number   Postode
Risk Address if different from Above    
How many years has the practice been trading      
Property Details      
Has the buildings fixed electrical
wiring system been inspected
and tested in the last 5 years		   Has a fire risk assessment of the
building been carried out by a
competent person in the last year		  
Is Property Standard Construction   If No provide full details of
construction		  
Does the property have a flat roof   If yes please select percentage  
Is Property Listed If yes what Grade Listed  
Sums Insured      
Buildings (Rebuild Cost) Tenants Improvements  
Contents (excluding computers)   Computer equipment value  
what value of contents is on fixed equipment   Stock
Annual Gross Fee Income of practice      
Claims Experiance      
Have you made any claims within the last 3 years   Number of claims made  
If yes please provide details of claims below      
Claim Type Date Of Claim Payments made  
   
Security      
Do you have key operated window locks on all accessible opening windows fan lights & sky lights      
Do you have BS3621 5 lever mortice deadlock on all entrance & final exit doors      
In their and intruder alarm at the risk address   If yes is it maintained under an annual contract  
Name of alarm company   NSI or SSAIB accredited  
What is the intruder alarm signalling meathod  
Please select all that apply		    
Are the premises protected by Local Authority CCTV   If other additional security measures please describe them in the box provided  
Important Note      

Any quote provided would be based on the following assumptions - 1) the property is not unoccupied for more than 21 consecutive days in any year; 2) the property is solely occupied by you as a dental surgery; 3) the property is not being in an area where flood, subsidence, heave or landslip are a problem now or have been in the past; 4) there are no large trees within 4 metres of the property; 5) there are no rivers within a close proximity of the property and 6) low pressure hot water, fixed gas or electrical appliances.

  If you can not agree to the important note please provide details.  
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