Lloyd & Whyte – Medical Division

Request Quotation

In order that we can provide a guaranteed 20% saving* on your forthcoming renewal all we require is your forthcoming renewal premium.

We will require proof of this and we will also need to capture the full details upon which your existing premium is based for underwriting purposes and to ensure that we can access your details on your behalf.

If you would like a quotation either call our team on 0845 241 3328 or complete the brief form below.

Thank you

	General Information
	Renewal date*
	Renewal premium*
	Existing insurer*
	You
	Contact name*
	Policyholder name*
	Practice trading name*
	Practice address*
	Post code*
	Telephone*
	Email*
	Full legal title*
	Number of years trading*
	The Premises
	Number of premises to be insured*
	Number of surgeries within practice*
	Is the premises of standard construction*
	If no please give details*
	Is the building solely occupied by you?*
	If no please give details*
	Is the property free from flood, heave, landslide and subsidence*
	Is Terrorism cover required*
	Security
	Are the premises protected by an intruder alarm system*
	If yes, what is the name of the maintenance company*
	What is the alarm signal method*
	Other? Please specify*
	What is the police response*
	Are the premises protected by local authority cctv cameras*
	Are they any other enhanced security measures*
	If yes please give details*
	Sums Insured
	Contents (excluding computers) £*
	Of which, how much is fixed equipment £*
	Computer equipment £*
	Buildings (rebuild value) £*
	Tenants improvements £*
	Loss of rent payable £*
	Loss of rent payable indemnity period*
	Loss of Gross Fees
	What is the annual income (including rent receivable) £*
	Indemnity period*
	Claims
	Has there been any accidents, losses or claims whether insured or not relating to the covers to which this quotation applies over the past 5 years (or number of years in business, whichever is the less)*

	If yes please provide details below
	Claim 1
	Type:
	Date:
	Cost: £
	Claim 2
	Type:
	Date:
	Cost: £

How did you hear about us?*


			*Mandatory Fields

*Subject to no more than 2 claims in the last 3 years. Complies to minimum security standards. Normal underwriting conditions apply.