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 Brokers National 

Brokers National Retail Shop Insurance Cover Includes: Fire & Perils, Business Interruption, Burglary, Money, Glass, Public & Products Liability, General Property, Computers, Machinery Breakdown, & Goods InTransit                                             All Covers Are Available Under One Convenient Package Policy                                               Did You Know You Can Select Higher Excesses To Reduce The Premium Payable                                      Simply Answer The Questions Below                                 Type Only The Sums Insured For Sections You Require              

EMAIL Or FAX: 

On-Line Retail Shop Insurance Quote


Thank you for considering our on-line retail shop insurance quote service. Brokers National has accounts with most insurers and underwriting agencies. We aim to find you the best retail shop insurance deal possible.

Please fill in the following form - answering all questions, then either:

1. Click on "Email to Brokers National" at the bottom of this form.  OR                               

2. Highlight this form to "Print It" and then "Fax It" to our office on 03 9791 6633.


Use the Mouse or the Tab key to move to the next field. We will respond with quotes as soon as they have been received from our insurers.

Retail Shop Details:

Your Current Insurer & Due Date:
Situation of Risk:
(& Postcode)
Business / Trading Name:
Company, Or Partnership Names
Occupation / Trade / Business:
Number of Staff: Full Time       Part Time
Approx. Annual Wages : $ per annum
Estimate Sales / Turnover / Rentals: $ per annum
Building Occupied By:
Years In This Business: years

Fire Insurance Details:
Approx. Age of Building:yrs    No.Of Stories:  Approx. Area:sq m
 Condition of Building          
Mortgagee / Interested Party
 
Fire Protection: Single sprinklers    Dual sprinklers    Hydrants/Hoses    Extinguishers          Fire Alarm  Thermal Smoke Detectors  
Cooking: Free Standing Frying Vat    Thermostatically Controlled    Bench Top Frying Vat    Griller    Pizza Oven   Rotisserie   Woks     Baking Ovens 

Construction Details:

Walls: Bricks/Concrete      Iron       Timber       Fibro                                            Mixed Construction Is
Roof: Iron      Tiles   Other
Floors: Concrete    Timber     Mixed   Other
 

Security Details:

Details about anti-theft protection you currently have:

Alarm: Monitored     Local Sounding    No Alarm   
Connection: Landline      S ecuritel      Dialler     No Connection  
Sensors: Infra Red     Window Detector / Tapes   
Deadlocks: All Doors    Other
Other: Security Patrols      24 hour Security Guard      Roller Shutter Front Window        Bars Front Windows      Bars Rear Windows     Safe On Premises    

Please detail briefly any insurance claims in the last five years:

IMPORTANT: Have you ever..........
Had any insurance cancelled or declined?              Yes     No                            
Been charged or convicted of any criminal offence? Yes     No                          Been bankrupt or placed in administration?             Yes     No  

Liability Details:

Sub Contractors: Do You Employ Sub Contractors    Do They Have Insurance                                 Give Details
Entertainment: Band/Disco   Solo/Duo   Dance Floor Other
Importing: Yes  No CountriesImports $
Exporting: Yes  No CountriesExports $

List Sum Insured Required:

Please enter the value to be insured against each item:

Fire and Accidental Damage
Building: $
Stock: $
Other Contents: $
Removal of Debris: $
Loss of Rent: $
Other Specified Property: $
Accidental Damage: $
Business Interruption
Gross Profit or Rent: $
Increased Cost of Working: $
Claims Preparation Costs: $
Payroll% for Weeks $
Burglary
Stock: $
Tobacco / Cigarettes: $
All Other Contents: $
Liquor / Alcohol $
Damage To Premises $
Money
In Transit: $
Business Hours $
Outside Business Hours $
Locked Safe: $
Residence: $
Glass
External:
 Internal:
Signs: $
Liability
 Public & Products Liability: $
 Property Owners Liability (If Buildings Are Insured): $
Goods In Custody: $
General Property / Mobile Equipment
General Property Total Limit: $
Single Item Limit: $   1,000
Specified Items Over $1,000 Per Item: $
Computers  (Breakdown Only)
Breakdown Of Electronic Equipment: $
Data Media $
Increased Costs $
Machinery Breakdown
Unspecified Motors / Equipment: $
Specified Items: $     

List Machines To Be Insured Below:                                                 

Food Spoilage: $
Goods in Transit
Goods in Transit Per Load: $
No. Of Vehicles To Be Insured Vehicles

Contacting you about your quote:

Please make sure you leave a contact phone number and the best time to call you.
Your Name:
Company name:
Your Phone Number & Area Code:
Best Time(s) To Call:
Please send my quote by (select at least one): email     phone     fax     mail
Your Email:
Your Facsimile:
Your Postal Address:

Click On Email Quote To Send         Form To Us
 

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