Business Interruption Form

Business Interruption Insurance (also called Loss of Profits) protects your business from disruption that follows a fire or similar disaster. Many people are not familiar with this insurance and the questions that follow will help us to advise you if you need this cover

if you are familiar with Business Interruption Insurance you can ignore questions 1 to 5 and answer questions 6 & 7 directly

1. Please choose one of the following which describes your main occupation

ManufacturerImporter / DistributerProvider of professional services for fees
2. What is your annual gross turnover?
3. What is the annual value of your purchases of raw materials?
4. What is the annual cost of freight for carriage of raw materials and finished goods?
5. How many months would it take you to rebuild completely your largest or most important location?

Do not answer these questions if you have answered Question 1 to 5

6. What is your annual Gross Profit?
7. What Indemnity Period do you need?

Declaration: We hereby declare that the statements made by us in this Proposal are, to the best of our knowledge and belief, complete and true, and we hereby agree that this Proposal forms the basis and is part of any policy issued in connection with the above risk(s)

Proposer(s)
Name
Email
Date

Important: No insurance is in force until this Proposal has been accepted by the Company