AT Bell Insurance Brokers

If you would like to receive a quotation please complete this form as completely as possible. We aim to reply to all enquiries as soon as possible.

Please state the type of premises:
Church:
Charity:
Conference & Activity Centre:
Your name:
Organisation:
Your address: (to be used for correspondence)
Postcode:
Phone Number:
Fax:
Email:
Sums insured for premises cover
Address of Premises to be insured if different from above:
Postcode:
Buildings:
Contents:
Specified all risks:
Money:
Stock:
Frozen Food:
Office machinery:
Personal accident:
Public liability:
Employers liability:
Have you made a claim in the last 5 years?	Yes No
If 'Yes' please advise brief details:
Present Insurer:
Present renewal date:
Present premium £:

AT Bell Insurance Brokers Ltd.
40 Croydon Road, West Wickham,
Kent BR4 9HT

Tel: 020 8462 0769
Fax: 020 8462 0773
E-mail: insure@atbell.co.uk

Sums insured for premises cover