Proposer's Name
Contact Name
Address
Postcode
Telephone
Email
Business Description
Are you a member of the Fitness Industry Association?
NO
YES
No of Years In Business
Number of Employees
Renewal Date
Renewal Premium
Premises Information and Cover
Address of Property if different
Construction of 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
- Other Occupants -
Yes
No
Other occupants
No
Yes
if yes
Approved Alarm
No
NACOSS
SSAIB
Alarm Signalling
None
Bells Only
Digicom
Redcare
Sums Insured
Buildings
£
Loss of Rent
£
Stock
£
Contents (ex Computers)
£
Computer Equipment
£
Tenants Improvements
£
Deterioration of Frozen Stock
£
Business Interruption
£
Business Interruption Indemnity Period
Months
Book Debts
£
Annual Turnover
£
Clerical and Sales Wages
£
All Other Employee Wages
£
Number of members over 18.
Number of members under 18.
Goods in Transit
£
Claims Experience
Date
Cause
Amount
Please use this space to tell us about any other factors that you may feel are important or may affect the opinion of underwriters in assessing the risks associated with the insurance proposed.