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M-Pharm Retail Insurance Quote

M-Pharm Retail Insurance Quote

1. About you

Your Name *
Email *
Preferred contact method

Do you have a preferable day or time for us to call you?
Pharmacy name *
Address *
Postcode *
Alliance Healthcare account number

2. Your current scheme

Current insurer
Date of renewal (dd/mm/yyyy)
Target premium? (£)
Current policy (Providing us with your current policy allows us to review your current cover, compare it with our policy and prepare a detailed quote.)

3. About the pharmacy

Please upload your schedule here

How much cover do you need for the following? (Enter £value or ‘n/a’ where appropriate)

Building sum insured (£)
Tenants improvements (£)
All non-specified contents (£)
Computer equipment (£)
Non-refrigerated drugs (£)
Refrigerated drugs (£)
Other stock (£)
Business interruption (£)
Indemnity period

Please provide as much of the following information as you can:

Pharmacy gross annual income (used to calculate business interruption cover) (£)
Year the building was built
Roof material
Wall material
Public liability

Employers liability £10,000,000 (standard UK limit)

Legal defence costs

History of flood?

History of subsidence?

4. About your security

Burglar alarm

Fire Alarm

5. Your claims history

Have you had any claims in the past five years?

If yes please give details below:
Please specify what MIAB can contact you about in the future:

How can we contact you regarding this:

To prevent spam, please enter the answer to the sum: 3 + 1

MIAB is a trading style of The Medical Insurance Advisory Bureau Ltd which is authorised and regulated by the Financial Conduct Authority under register number 586374 and holds Interim Permission as a Credit Broker (interim permission number: 654571). MIAB does not charge any fees to customers in relation to Credit Broking activities. In Jersey, MIAB is regulated by the Jersey Financial Services Commission Ref: GIMB0222. The Medical Insurance Advisory Bureau Ltd Registered in England and Wales No. 7217140 Registered office: Affinity House, Bindon Road, Taunton, Somerset, TA2 6AA. Copyright © 2016 The MIAB. All Rights Reserved.

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