Helpline: 020 7481 4321

Quotation Request

Restaurant Scheme

Client Details
General Questions
Premises
Sums Insured
Claims
Declaration
Additional Notes
Calculations
Square Mile
Personal Touch

Client Details

Company Name
A limited company or name trading as
Risk Address:
Is the correspondence address different from the insured premises?
Correspondence address:
Contact Name
Client Name:
Director Date Of Birth:
First Name
Surname
Mobile Number
Phone Number
Email Addresss


Please specify your business type:
Do you wish to note a third party interest under this policy?
Please fill in the details for the insured parties:
NameAddressType
Add row
Percentage of Take Away business
%
Date Established
Are you exempt from PAYE?
ERN
This is your Employers Reference Number (Also known as PAYE Ref) which you can get from your accountant
Employers Reference Number
/
Inception Date
at
Does the proposer have a nightclub, disco or dance floor on the premises?
Only say Yes if this is regularly used for this purpose. i.e weekly
Does the proposer offer any form of entertainment?
Only enter Yes if you have regular live music
Does the proposer employ door supervisors?
Do you request copies of their insurance
Does the premises operate a late licence?
Are you regularly open past 1am
Please provide details:
Does the premises charge any form of entry fee?
Only tick Yes if you regularly charge entry fees for events
Do you allow the smoking of sisha at your premises?
Is this in an outside designated area?
Please provide details:
Do you have a written Health and Safety Statement?
This is not to be confused with a Health and Hygiene certificate
This is a legal requirement and template documents can be uploaded from @@@@@@@@@
Do you have a electronic copy of your Health and Safety documents that you wish to upload
Please upload a copy of your most recent Health and Safety documents:
Are you a member of any trade associations:
Membership Number:
Please specify:
Please specify the opening times:
Please specify the evening times:
**Hidden** Renewal Date for Document

General Questions

a) Does the property have walls of brick, stone or concrete?
Please provide a description:
b) Does the property have a roof of slate, tile, metal or concrete?
Type of construction of your building roof
Is there any flat roof?
Please give a brief description of the type of flat roof:
Please specify percentage of flat roof:
%
c) Is the property in a good state of repair and kept in a like manner?
d) Does the property have a listed status?
Please provide the listed status
e) Does the property have a basement?
f) Is the property permanently occupied throughout the year?
g) Is the property fully occupied solely by the business?
Is the premises fully self contained and separate from any other business
h) Is the property occupied by the proposer or their representative overnight?
i) 1) Is the property free from storm exposure?
Has there been any flooding in the last 5 years
2) Is the property in an area which is free from flooding and at least 250 metres from nearest waterway
j) Is the property free from subsidence, heave or landslip?
Has there ever been any signs of cracking or drain damage in the last 5 years
k) Does the property have residential accommodation above the business? & accommodation is NOT let to any DSS / students / asylum seekers?
Is it privately let by the landlord
Is it privately let to staff:
l) Is the property within a shopping mall?
Do you require Terrorism Cover:
If required this will be quoted on a separate policy but included in your quotation.

Premises

Does the insured operate Deep Fat Fryers on the premises other than work-top fryers of equivalent capacity?
For the purpose of this Condition basket top, table top or portable fat fryers are not considered to be deep fat frying equipment
Do you have thermostatically controlled shut off?
Do you have a fire suppression unit?
Does the final exit door of the premises has 5 lever mortice dead lock and is of Timber or steel framed, Or if UPVC or aluminium has cylinder deadlock or multi-point locking system?
Does any adjoining door (to property not in the insured control) have the same security as above?
Does the property have adequate Fire Extinguishers?
Are there enough upto date extinguishers on each floor and kitchen of the property
Does the property have an automated Fire alarm?
Is the fire alarm maintained by an accredited association
Fire Alarm Signalling Method
Does the premises have an operational intruder alarm?
Is the intruder alarm maintained by an accredited association?
Does the premises operate closed circuit television (CCTV)?
Is this central station monitored?
Does the property have Bars or Shutters installed and in use?
As the premises does not have CCTV, bars or shutters, what other security measures does the premises have operational?
What year was the building built:
Do you undertake any outside catering?
This relates to you catering an event away from your premises
Do you have a Electric Certificate?
This will affect any claim that relates to an electrical fault
It is warranted that the electrical installation be inspected and tested every five years by a contractor approved by the National Inspection Council for Electrical Installation Contracting (NICEIC) and that any defects found be remedied forthwith in accordance with the Regulations of the Institute of Electrical Engineers. Any defect with a recommendation of Code 1 or 2 must be remedied within 30 days.
Please upload here if available
Electric test date:
Please give details of adjoining buildings

Sums Insured

The Premises:

Section A - Buildings
Building Discount
£
Tenants Improvement Discount
£
Loss of rent Discount
£
Indemnity Period
Section B - Contents
Trade Contents
These are all the furnishings from fridge freezers, Tandoori including tables, chairs and plates etc...
£
Trade Contents And Tenants Improvements (If Required)
£
Contents
£
Contents next 40k
£
Contents next 80k
£
Contents Remaining Balance
£
Contents Discount
£
Stock
This is your meat, vegetables, spices, soft drinks and beer
£
Wines and Spirits
This should only be your spirit alcohol, wines and champagnes
£
Electrical Equipment / Computers
This is your EPOS and extra terminals and electronic tills
£
How many freezers do you operate:
Is there a walk in chiller or freezer?
Please supply
MakeModelAge
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Section C - Business Interuption
Indemnity Period - Aviva
Indemnity Period - One
Please specify the amount of Business Indemnity you require
£
Section D - Liability
Employers Liability
£
Products Liability £5,000,000
Section E - Money
1. In the Premises during Business Hours or in transit or bank night safe:
£
2. Out of Business Hours, In Safe
£
3. Out of Business Hours, Out o Safe
£
4. In Directors, Partners or Designated Emplyees PDH
£
Extension 5 - Assault
a) Death £10,000
b) Total and irrecoverable loss of sight in one or both eyes £10,000
c) Total loss of use of an entire hand, arm, foot or leg £10,000
d) Permanent total disablement from usual occupation £10,000
e) Temporary total disablement from usual occupation £100 per week
Section F - Frozen Foods
Frozen Foods:
£
Section G - Loss of License
Total Sum Insured £500,000
Section H - Book Debts
Total Sum Insured £5,000
Business Interuption
£
Outside Catering:
£
Public Liability:
£
Deterioration of Stock:
£

Claims

Have you experienced any losses or incidents that may give rise to a loss in the past five (5) years?
Does this relate to
Claims List
Date of LossClaim TypeClaim DescriptionAmount PaidReservedSettled
Add row
Year

Declaration

I/we declare the following:
The following assumptions have been made about the Proposer, the Premises and the Business activities undertaken.

The Proposer/Partners/Directors:

have never been declared bankrupt or insolvent or been the subject of bankruptcy proceedings either as private individuals or in connection with any business or

been the subject of a county court judgement in respect of debt either as private individuals or in connection with any business or

been officers of any company that has been declared insolvent or had a receiver or liquidator appointed or entered into arrangements with creditors in accordance with the Insolvency Act 1986 or any equivalent or subsequent legislation.

have not have had any convictions or criminal offences, which are not spent under the Rehabilitation of Offenders Act, or prosecutions pending other than for motor offences.

have never had a proposal for business insurance refused or declined or ever had any business insurance cancelled, renewal refused or had special terms imposed.

Each Premises to be insured:

Has not suffered any previous Damage caused by subsidence, landslip or heave and shows no signs of any Damage caused by subsidence, landslip or heave.

Each Premises to be insured:

Has not suffered any previous Damage caused by flood in the last 5 years and there has been no history of flood in the last 5 years within 50 metres of the Premises.

Although you have ticked disagree we can provide you a quotation and someone will be in contact..
Please specify where you heard about us:
Do you currently have any other insurance taken out with us?

Additional Notes

Additional Notes

Calculations

Postcode 2 Characters
Postcode for lookup 3 Characters
Postcode 4 Characters
Postcode 5 Characters
Theft Code
Theft Code Overwrite
Flood Category
Subsidence Number
Square Mile Reference
For documents only
Subsidence Excess
£
Increase Subsidence
Increase Flood
Contents and Stock Total
£
Subs Rating
MD Arson colour:
SW Colour:
Theft Code Aviva
Business Interuption
£
Commission
£
All Contents and stock Results
£
Money
£
New Contents
£
Year
Sender ID
Full Postcode
Year Number
Broker Commission Amount
£
Sig premium excluding IPT
£

Square Mile

Commission Percentage
Building Si Rate
Tenants Improvements Rate
Tenants Improvement Discount
Tenants Improvements included in Contents
Loss of rent Rate
Loss of rent Discount
Contents Discount Rate
Stock Rate
Wine Rate
Tobacco Rate
Electrical Rate
Fire, Alarm, Roller and Occupied Overnight Discount Rate
Deterioration of Stock Rate
No Claim Discount Rate
BCA Discount Applicable
BCA Percentage
Multi Discount
Discretionary Discount
Square Mile Load Percentage
Minimum Premium
£
Outside Catareing Increase
£
Would you like to include the hot food paragraph?
Pay by Cheque or direct debit
Flood Excess Amount
£
TAM number for debit note
Please put MTA reason in to go into MTA extra letter?
MTA Schedule Reason:
Renewal reason for renewal letter.
Risk Referred to Aviva
Is a survey required?

Personal Touch

Letter Notes
MTA Extras Letter Wording