General Property/Liability Enquiry Form (fields with * are mandatory) Name of Client* Email Address Address Company Type Sole Trader Partnership Limited Company Renewal Date Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Business Description No. of yrs in business on own account Name of Previous Insurer Do you have a safety statement Yes   No Claims History (Records with empty Claim Year will not be saved.) Year Circumstances Paid Out Outstanding Property Damage Quote Required Yes   No   Sum Insured € Buildings Fix/Fittings Tobacco Contents   Sum Insured € Machinery Stock (excluding Tobacco) Work in progress Other Construction of Building Roof No of Storeys Do you live on premises Walls Heating Other Businesses or occupants of the premises Details of Fire Precautions: Alarm/Fire Blankets/Fire Extinguishers/Sprinkler Business Interruption Quote Required Yes   No Estimated Gross Profit (€) Indemnity Period -- 12 18 24 Months Loss of Rent Cover Required Yes   No Estimated Rent Receivable Indemnity Period -- 12 18 24 Months Following an interruption to the business caused by fire or other peril as under the Property Damage section. Employers Liability Quote Required Yes   No No Total Wages (€) Estimated Wages of Direct Employees: Clerical Manual Employees (excl. Woodworking Operatives) Woodworking Operatives Estimated Payments to Labour Only   Working Directors All Other Employees (excluding Bona-fide Sub Contractors) Cover is provided for bodily injury sustained by employees for which you may be liable up to a limit of €12,697,380 Public / Products Liability Quote Required Yes   No Estimated Annual Turnover € Estimated Payments to Bona-fide Sub-Contractors € (NB. Bona-fide Sub-Contractors are Sub-Contractors who supply their own materials on site.) Do you use any Burning or Welding Equipments Yes   No   Does work Away Apply Yes   No If Yes, % of work which is Work Away: % Money Quote Required Yes   No Glass Quote Required Yes   No Deterioration of freezer stock Quote Required Yes   No Deterioration Quote1 € Deterioration Quote2 € Goods in transit Quote Required Yes   No Computer Breakdown Quote Required Yes   No Cover is provided in respect of damage to Computer Property resulting from breaking, distoration or electrical burn-out of any part due to inherent defects. Additional Comments