Name
Company Name
Address
			Postcode
Email			Telephone
Business Description
How long trading?
The Premises
-Walls - Brick Brick/Steel Steel Wood Concrete Other - Roof - Slate Steel Concrete Timber/Felt Other - Floors - Concrete Stone Wood Other - Heating - Gas CH Electric Oil Portable Heaters None
- Electrics Checked - Less than 12 months Less than 3 years Less than 5 Years Other - Intruder Alarm - BT Redcare Digital Commmunicator Bells Only None - Alarm Maintained - Yes No
Who else occupies the premises?			- Other Occupants - Yes No
Buildings
Stock
Own Vehicles
Customers Vehicles
Portable Handtools
Fuel in Tanks
All Other Contents
Gross Profit
Fixed Glass
Cash in Safe
Cash in Transit
Annual Carryings of Money
Goods in Transit
Annual Turnover
		- Defective Workmanship - Required Not Required
Please spilt the annual turnover by % to each activity
Sale of New Vehicles	0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%	Sale of Used Vehicles	0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%
Repair/Service	0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%	Bodywork	0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%
Commercial Vehicles	0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%	Recovery	0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%
Valeting	0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%	Motor Cycles	0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%
Other Work				0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%
Annual Wages	Clerical
	Manual
Road Risks Cover
- Cover Required - Comprehensive Third Party Fire and Theft Third Party only Current No Claims Bonus None 1 Year 2 Year 3 Year 4 Year 5+ Year Trade Plates None One Two Three Four Five
Demonstration Cover Required Yes No - Loan and Hire Required - Yes No Recovery Yes No
Driver	Age DDMMYY	Position	Acc/Conv	SDP Vehicle
Proposers own vehicles
Make	Model	Registration	Value
Have you had any losses in the last three years?				Choose Yes No
if yes, please give details
Existing Insurer
Additional Information