Full Company Name: (required)

Contact Telephone: (required)

Your Email: (required)

Postal Address:

Stock Location:

Web Address:

Legal Status (ie. Limited / Sole Trader):

Details of products sold?:

Are all products sold to the general public?
 Yes No

How long have you been trading?

Annual Turnover:

Gross Profit:


Do you have any employees?
 Yes No

If YES, what are the annual salaries?

Do You Export to USA or Canada?
 Yes No


If YES -
What is the percentage of sales:

How long have you been exporting?

Do you have any assets or representation in the US? (excluding stock)
 Yes No

Do you have any contracts in force with US customers?
 Yes No

Are you an Amazon FBA Retailer?
 Yes No

In which countries are the products manufactured?

Please confirm whether you yourselves inspect goods or whether you use a Third Party Inspection Agent to quality control inspect goods manufactured outside of the EU, prior to the goods leaving port of origin and if so, please confirm the identity of the relevant Third Party Inspection Agency?

Are any of the products designed or modified by you?
 Yes No

Are any products sold with a brand name or trademark owned by you?
 Yes No

Is you stock location protected by a NACOSS approved BT Redcare Alarm?
 Yes No

Please indicate which of the following additional security measures are in place at the stock location?
Alarm  Yes No
CCTV  Yes No
Roller Shutters  Yes No
Bars / Grilles  Yes No

Stock location occupied overnight?
 Yes No

Are all the Premises of standard construction (built of brick or stone and roofed with slate, tile, concrete, metal or asbestos?
 Yes No

If NO - please provide details:

Are all Premises in an area been free from flooding in the last 5 years?
 Yes No

Buildings Sum Insured:

Stock Sum Insured:

All Other Contents Sum Insured:

Tenants Fixtures & Fittings Sum Insured:

In respect of ANY of the risks to which this proposal relates, has any claim been made?
 Yes No

If Yes, please give details :-

Claim 1



Date of Claim or Loss:

Brief Details

Cost of Claim / Loss

Estimated Cost of Claim / Loss Outstanding


Claim 2



Date of Claim / Loss

Brief Details

Cost of Claim / Loss

Estimated Cost of Claim / Loss Outstanding


Claim 3



Date of Claim / Loss

Brief Details

Cost of Claim / Loss

Estimated Cost of Claim / Loss Outstanding


Claim 4



Date of Claim / Loss

Brief Details

Cost of Claim / Loss

Estimated Cost of Claim / Loss Outstanding


Declaration

I/We declare that after full enquiry, the contents of this questionnaire are true and that I/We have not misstated, omitted or suppressed any material fact or information.

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