pro-indemnity.co.uk Cafes and Restaurants Form 1. Your Name:  Company Trading Title:  Type of Company: Sole TraderPartnershipLimited Company- 2. Address of your premises:  Post Code:            Telephone Number:  E-mail address:  Website address: 3. Description of Business:  Do you do take-away?  Yes No  Do you do home delivery?  Yes No 4. Date Established: 5. Layout of premises: (eg flats above, owner occupied, layout of adjoining properties, freestanding building...) 6. Does your premises have own lockable entrance: Yes No 7. Construction of premises (eg. Brick walls, Mild steel roof)  Is there a partial / full flat roof Yes No  If "Yes" describe in detail:  Type of heating at premises: (please give details of fuel, type, and controls) 8. THE LOCATION OF PREMISES: High StreetIndoor shopping centre / mallBusiness ParkOther-  If other, give details:  Are there any rivers or watercourses near the premises?  Yes No  If "Yes" please give full details  Approx distance from Police Station (Miles):    Approx distance from Fire Station (Miles): 9. YOUR BUSINESS :  Do you have a basket fryer?  Yes No  Do you have a deep fat fryer?  Yes No  If "Yes" describe in detail:  Number of seats: (covers)  Do you have a children's play area?  Yes No  If "Yes" please describe in detail:  Do you have an Electrical Installation Certificate?  Yes No  Do you have a liquor license?  Yes No  Do you have an entertainament license?  Yes No 10. SECURITY AND FIRE PRECAUTIONS Are the premises fitted with a:  Fire alarm:  Yes No  Sprinklers:  Yes No  Fire Extinguishers:  Yes No  Are fire extinguishers inspected annually?  Yes No  Are door locks 5-lever mortise deadlock type?  Yes No (eg Chubb locks)  Are window locks fitted?  Yes No  If you chose 'no' for either of the last two questions, please give details of what you do have for physical security. 11. BURGLAR ALARM  Is there a burglar alarm under your sole control  Yes No  If "Yes" please state: to Police Stationto Central Monitoring StationPrivate line to yourselvesBells only- 12. INSURANCE HISTORY  Have you had any previous insurers:  Yes No  Name of current insurers (so that we don't approach them!)  Expiry date of current insurance  Current premium (if known) £  Have you ever been declined, cancelled, refused or special terms:  Yes No  If "Yes" please give full details  Have you had any claims? Yes No  If "Yes" please state here: Date of claim: What happened: Total Payment: 13. SUMS INSURED SUM INSURED  Buildings (including outbuildings): £  Tenant Improvements: £  Stock in trade (exc wines/spirits): £  Stock (wines & spirits): £  Loss of license: (Value of business lost if you were to lose your liquor licence) £  Fixtures & Fittings: £  All other contents: £  Computer Systems: £  Do you have an ATM in your premises?  (Note that if you DO have an ATM, you will need to fill out the ATM Questionnaire, available by clicking here.)  Yes No Note : INCLUDED AUTOMATICALLY IN QUOTE - LOSS OF PROFITS EMPLOYERS LIABILITY PUBLIC AND PRODUCTS LIABILITY GLASS BREAKAGE MONEY GOODS IN TRANSIT If you live on the PREMISES and would like a Quote for Personal Contents, please advise  Yes No Please supply me with an estimate within 105 working days. (We will attempt to meet the target, but please be aware that it does require our insurers to respond quickly as well!) Done   Please check your details, and when you are happy that all is correct, tick 'Done' and click the Submit button above...