Isra Insurance

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This information is solely for our marketing purpose.

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Personal Information

Title *

First Name *

Surname *

DOB: *

Employment Status *

If Employed/Self Employed, what is your occupation:

If Employed/Self Employed, what type of business:

Your Details

Contact Details:

Mobile / Telephone Number: *

Email Address:

Business / Trade Address:

House Number: *

House 1st line of Address: *

Postcode: *

Year established at this address since:

Correspondence Address (If Different)

House Number:

House 1st line of Address:

Postcode:

Company Details

Current/Previous Insurer

Company Status

Business, Company or Partnership Name

Business Description?

If other please specify the business type:

What date was your business established? (DD/MM/YYYY)

Total number of employees including partners, principals and directors

What is your Estimated Annual Turnover?

What is your Estimated Annual Wages?

If you are running a: Café, Take Away and Restaurant: Yes No

Café, Take Away and Restaurant Details

Percentage of collection: (Please specify in the box)

How many persons could be dined at a time? (Please specify in the box)

How often the kitchen extractor fan is cleaned?

Daily Weekly Monthly Half-yearly Yearly

Is your fryer a standing fryer or just a small basket fryer?

Maximum how many liters of oil the fryer can occupy?

Cover Details

Is the Premises’ Owned / Leased / Rented by you?

Do you require buildings cover?

Yes No

What’s the maximum cash amount to be covered during the business hours?

Do you want any cash sum to be covered outside the premises?

Yes No

Stocks to be insured:

Cigarettes, Cigars and tabacco sum insured amount

Wines, Fortified Wines and Spirits sum insured amount

Frozen items to be insured

Other Stock (other than target stock shown above) to be insured

Contents (Fixtures & Furniture’s) sum insured amount

Contents (If any Till, Computers & other electrical Equipment’s) sum insured amount

Claim Summary

Have you had any losses or incidents that have or could have given rise to claims (whether insured or not) in the past 5 years in connection with your current, or previous, business?

Yes No

Employer Reference Number Details

Are you exempt from paying PAYE?

Yes No

Please provide your Employer Reference Number

Policy Start Date

When would you like your policy to start

Additional comments:

with our stated Terms and Conditions & Privacy Policy

By clicking submit, you agree your explicit consent for us to use the data provided in accordance with the Data Protection act 1998, this data will be used to provide the cheapest possible quote while being shared with both offline and online markets.

Business Insurance Quotation Form

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Café, Take Away and Restaurant Details

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