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Insurances > Business premises

 Insured:

Name:

Sir Name:

Email:

NIF:

Adress:

Town

 P.C.:

Province:

Sex:

 Male   Female

Date of birth:

 (day/month/year)

Occupation:

Marital status

Single Married Divorced Widow 

 Insured risk:

Situation:

Town:

 P.C.:

Province:

Telephone:

 Risk assessment:

Year of building or rebuilding:

m2:

Type of activity:

 Building material:

Structure:

Non-combustible Combustible < 30%
Combustible > 30%

Building envelope:

Non-Combustible
Combustible < 10%

Roofing:

Combustible Combustible > 10%

Material of false ceiling:

Non-Combustible Non-Combustible > 90%
Combustible > 10%

 Fire:

Are dangerous products being stored?:

Yes No
Which?: 

Quantity: 

Public fire station:

Less than 15 km away
More than 15km away

Means of protection:

Fire extinguishers  Fireplug
Sprinkler system

Permanent surveillance:

Yes No

 Means of protection::

Main door:

Back door:

Windows:

Showcase:

Are the premises protected during the siesta (mid day)?:

Yes No

Are the being surveyed permanently?:

Yes No

Do you have exterior protection with alarm? :

Yes No

Do you have interior volume detection?:

Yes No

Is there a connection to an security company?:

Yes No

Are your premises located on the first floor or above?:

Yes No

 Electronic equipment:

Quantity:

Description:

Age:

Amount:



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