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PPS GI : Surgery Insurance Form
Practice Name:
Practice Address:
 
 
 
Postcode:
Name of Contact:
Daytime Telephone No:
Email Address:
Number of Vets:
Number of Employees:
Renewal Date:
Current Insurer:
Current Premium:
   
Risk Information  
1. Are the premises you occupy of standard construction with tiled roof Yes No
2. Are the premises occupied solely by you? Yes No
3. Do the premises include:  
   - 5 lever mortice deadlocks to all exit doors?
 Yes No
   - Key operated locks to all opening windows? Yes No
   - An operative alarm system? Yes No
   - If yes, is it NACOSS or SSAIB? NACOSS SSAIB
   - If yes, is it Bells only / Central Station / Redcare? Bell only Central Station Redcare
4. Do you have any other security measures in place? Yes No
   
Please give details of any claims in the last five years with dates, details and amount claimed.
   
Sums Insured  
1. Buildings
 £
2. OR Tenants Improvements £
3. Contents (inc. drugs & stock) other than computers £
4. Domestic Contents £
5. Computers £
6. Refrigerated Drugs/Stock £
7. Equipment used away from the premises £
8. Number of Medical Bags   
9. Animals in your custody £
10. Business interruption £
11. Indemnity period (12, 18 or 24 months) 12 18 24
   
 
 
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