logo

RETAIL MARKET TRADERS START-UP INSURANCE PLANS
APPLICATION FORM

Please note that this application form is not touch screen enabled and should therefore not be processed using a touch screen device

Answers to the following questions and any additional details presented to the Company assist us in the assessment of the risk. You must let us know all material facts relevant to this insurance. Failure to do so could result in you not being insured and claims being refused. Material facts are those which would be likely to influence an insurer’s consideration of the application. If you are in any doubt as to whether a fact is material you should include it. You should keep a record (including copies of letters) of all information supplied to the Company in connection with this insurance.

Applicant Details

Name of applicant

Title


First name




Last name

Trading as

Name of establishment to be insured

*

Legal trading status

i.e. sole trader, limited company etc

Sole trader Partnership Limited company *

P.A.Y.E. (Employers) Reference Number

Not applicable if you are a sole trader and do not employ anyone

Yes (ERN) Exempt Awaiting details from HMRC *

Type of Market/Exhibition you will be trading from

i.e. indoor market, outdoor market, indoor exhibition, outdoor exhibition, craft fair, boot sale, if other please advise

Indoor market Outdoor market Indoor exhibition
Outdoor exhibition Craft fair Boot sale
Other (please advise) *
We are unable to provide insurance to cover you whilst trading simultaneously at other markets please call LRO on 0207 194 8257 to obtain terms.

Do you operate from a stand/stall/pitch/kiosk - if other please advise

Stand Stall Pitch Kiosk Other (please advise) *

Description of goods/services sold/offered

i.e. crafts, clothing, fashion goods, hand bags etc.

*

Your Details

This is required for cover approval and sign-up

Mobile Number *
Email *

Address to which Policy will be issued or sent

Postal Address *
Postcode *
Town / City

Product Selection

*

PL Limit of Indemnity £5,000,000
Products Limit of Indemnity £5,000,000
EL Limit of Indemnity £10,000,000

Date upon which the insurance is to commence

*

Note: This insurance will not be, or continue to be, in force until this application form has been accepted by the Company.

x

Please Check the following