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Pharmacists Commercial Insurance

Online Questionnaire

Contact / Address Details

Contact Name

Address (To Be Insured)

Postcode

E-mail Address

Contact Telephone Number

Name Of Pharmacy

How Long Occupied By You

Construction

Walls (ie. Brick, Stone, Wood, etc.)

Floors (ie. Concrete, Steel, Wood, etc.)

Roof (ie. Slate, Tile, Flat, etc.)

Security

Is Alarm Maintained By A Nacoss Approved Company (If No Alarm State No Alarm) Yes No No Alarm

Alarm Signal (Bells Only, Central Station Red Care, etc)

CCTV Yes No

Occupied Overnight Yes No

Is Property Under Your Sole Control Yes No

Sums Insured

Buildings

Stock

Electronic Office Equipment (Including Computers)

All Other Contents

Is Public / Products Liability Required

Previous Insurance History

Insurer

Renewal Date

Premium

Any Claims In Last 3 Years Yes No

If Yes Please Confirm Dates, Circumstances & Costs

© 2003 - 2008 Marcus Hearn. All rights reserved.
Marcus Hearn is a trading style of CBG London Ltd
Authorised and Regulated by The Financial Services Authority (FSA), Firm Reference Number 304771.
Registered Office: Barton Hall, Hardy Street, Manchester, M30 7NB
Registered in England and Wales, number 0894664