Surgery Insurance Quote

Surgery Quote

Complete the quote form below for a quote on your surgery and one of our specialist advisors will call you shortly with a quotation. Alternatively call 01473 269443

Renewal Date:		DD/MM/YY
Renewal Premium (£):
Insurer/Broker:
Customer Details
Proposer's Name
Address
Street
Town/ County
Postcode
Telephone Number
Email address
Property Details
Construction
Is Property Listed		if yes grade 1 or 2
Does the Property Have a Flat Roof		If yes what percentage
Other Occupants
Sums Insured
Contents (Excluding Computers) £			Computer Hardware £
Buildings £			Computer Software £
Book debts £			Tenants Improvements £
Annual Gross Fee Income of the Practice £

Claims Experience
How long has the proposer been in business yrs			Any claims in last 5 years?		yes
					no
If yes, please provide following details:
Type of Claim			Payment made £		Date



Security
Do you have window locks on all accessible windows?		yes no
Do you have 5 lever mortice deadlocks on all entrance and final exit doors at the premises?		yes no
Is there an alarm at the premises?		yes no
Name of Alarm Co
Is it maintained under an annual contract?		yes no
What is the signal method?
Are the premises protected by local authority CCTV?		yes no
Subsidence Details
Is the Property in a Flood, Subsidence, Heave or Landslide Area?		yes no
If YES, please give details
Optional Covers
Practice Overheads	Professional Indemnity for Nurses	Inspection		Terrorism