Commercial Property Underwriting Facility

Name of Broker or Intermediary

Broker's Address

Broker's Post Code

Broker's Telephone Number

Broker's Fax Number

Broker's Email Address

Name of Client

Occupation of Client if other than Property Owner

Risk Address

Post Code

Age of Property

Number of Floors

Construction

Walls

Roof

Floors

Please state Full details with regard to occupation of ALL tenants contained within the property

How long property owned?

Current Insurers

Current Premium

Please note that ALL RISK cover applies

Do you require SUBSIDENCE? YES NO

Building Sum Insured

Day 1 Adjustment required (if applicable)

Sum Insured for Contents of Common Parts

Annual Rental Income

Indemnity Period Required

Property Owners Liability: Please state indemnity limit required