+ Click here if you are an insurance broker

This section to be filled in by insurance brokers only

Name
FSA number
Email Address
Email Address (confirm)
Phone Number:
Business Name (broker):
Address 1:
Address 2:
Town / City:
Postcode:

Name
Company
Address 1
Address 2
Address 3
Postcode
E-mail
Phone
Type of Catering Undertaken	1. Mobile/Trailer 2. Outside 3. Cafe/Restaurant 4. Pub/Club/Canteen Franchise
No of customer seats you provide
Annual Turnover £
Payroll £
No of Employees
Previous Loss Details (leave blank for none)
Do you wait at tables?	No  Yes
Description of catering activites including any Additional Information
Premium