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Quotation Form

Complete the form below and we'll calculate your quote and contact you directly to go through the details.

Business Details

Proposer Name
Trading Title
Trading Address
Telephone Number
Fax Number
Email Address
Website URL
Date Cover Required /
If we have asked you to quote a reference, please enter it here
Are you an ActSmart member? Silver   Gold   Platinum   No
If you are please provide your member No.
Have you or your mechanics achieved Cytech Technical Two or above accreditation? Yes    No
Current Insurer
Current Renewal Premium £

Sums Insured

Building £ Rebuilding Figure
Including a value for
Architects fees,
removal of debris.
Tenants Improvements £
1.  STOCK  
Cycles & Accessories (incl. customers cycles in for repair etc) and any other stock for sale. £ Original Trade Price
Including removal of debris.
Equipment and other contents including computers, tools, tills telephone system etc. £ Replacement Figure
Including removal of debris.
Annual Turnover £
Annual Gross Wageroll £

Employers Liability Tracing Office

Claims made against Employers liability insurance can involve instances of long term injury and disease occurring over many years and to assist in your protection Insurers are required to obtain certain information from all employers to assist in tracing the insurers involved. Can you therefore answer the following questions:


1. Do you have any employees? Yes    No
If Yes, please advise your Employer reference number - ERN (see note below).
  • The ERN is often referred to on tax forms as employer’s PAYE reference and is provided by HMRC to every business registered with them as an employer. It can be found on many official documents such as P11D, P45 and P60. For example it is in the format 765/PA12345 (not the 13 digit number).
Some employers who pay all their employees below the PAYE threshold (£503.00 monthly) will be exempt as they do not have an ERN. If this applies to you, please indicate below.
2. We do not have an ERN as all our employees are paid below the PAYE Threshold (see note). Yes    No

Additional Cover

1. Money in Transit (£2500) £ If you require more than standard Policy limits as shown within the Policy Cover.
Money at Premises (business hours) (£5000) £
Money in Safe (non business hours) (£5000) £


Do you supply goods to the USA/Canada? Yes    No
Do you import goods from outside the EU? Yes    No
Do you sell second-hand bicycles? Yes    No
If Yes does this activity exceed 25% of sales? Yes    No
Number of years in business at these premises?
Have you had any insurance claims
in the past 5 years?
Yes    No
If yes, please specify breif details of date,
type of claim and payment:

Internet sales

Does your website allow purchases to be made? Yes    No
If yes, please advise approximate percentage of sales derived from the Internet. %

Sale of hazardous goods

Do you store or sell any of the following types of goods? Yes    No

Medical or health products.

Flammable liquids or gaseous fuels including "camping gas" type canisters fireworks.

Children's toys which do not carry the CE mark as per the criteria set by the EC Toy Safety Directive (88/378/EEC).

If yes, please supply full details

Important information

Construction of walls and roof of premises and any out-buildings
Is there any sign of cracking, subsidence or heave in your property or in neighbouring properties, or is the area a recognised subsidence area? Yes    No
Are the premises alarmed? Yes    No
If Yes please provide details of
the type of installation, ie. method of signalling such as BT Redcare/DualComm and the level of police response.
NACOSS or SSAIB approved? Yes    No
Annually Maintained under agreement? Yes    No
Please detail physical protections e.g. security shutters to Doors and Windows

Additional Information

Do you attend exhibitions? Yes    No
If so, please give an approximate number
Are there any other activities you engage in other than retail including repair and/or hire of cycles? Yes    No
If so, please give full details

I confirm I have read the Statement of Fact and comply with the statements made. Yes
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