Insurance Vision Business Insurance Quote Form Fire is perhaps the worst event your business can experience. It is very important that your buildings and contents are insured for their full replacement value. The same can be said for calculating your loss of profits. Property insurance covers your physical assets but you need Loss of Profits insurance to cover the ongoing expenses that occur after a loss eg. wages, loans and other additional expenses. By completing the form below, we will provide a quote that protects your business against that unexpected event. ---------------- * Denotes Mandatory Field ---------------- Personel and Contact Details Full Name*   Email Address*   Telephone Number   Fax Number   Who has referred you to Insurance Vision?   Details of the business and/or premises Type of Business (eg. Milk Bar)*   Street Address*   Town/Suburb*   Postcode*   Construction of Walls* -- Please select construction of Walls -- Brick Concrete Wood Iron Other   Construction of Floors* -- Please select construction of Floors -- Concrete Wood Earth Other   Construction of Roof* -- Please select construction of Roof -- Iron Concrete Tile Other   Year Built   How are premises protected? Tick the boxes that are applicable. Sprinkler System   Automatic fire alarm   Fire Hoses   Extinguishers   Fire Blanket   Dead Locks on doors   Bars and/or Keylocks on all external windows   Burgular alarm system -- Please select type of Alarm -- None Local Dialler Securitel Landline   Fire & Perils Building (including all improvements)   Stock   All Contents & Plant/Equiptment   Business Interuption Gross Profits/Fee income   Increased cost of working to keep business operating   Claims preperation costs   Uncollectible debts   Burglary Stock   Other Contents   Money Money in Transit   Money in buildings during Business Hours   Money in buildings outside Business Hours   Money in buildings while in a Locked Safe   Money in a Private Residence   Damage to safe or Strongroom   Glass Value of External Glass   Value of Internal Glass   Fronted -- Please select fronted type -- Single Fronted Double Fronted Multi-Fronted Factory   Public/Products Liability Limit required* -- Please select required limit -- Not insured 2 Million 5 Million 10 Million 20 Million   What is the annual turnover/sales of the business*   No of Staff/Employees*   Wages   General Information Have you or any of the persons to be insured in the past 5 years...* Made a claim on any insurer for loss or damage?* Yes No Had any insurance declined or cancelled or had a renewal* Yes No If you answered "yes" to any of the above, please give details.