Insurance and Financial Services
for the Chiropractic Profession

Chiropractic Clinic Insurance

To discover the benefits of insuring your Clinic through Lloyd & Whyte simply complete the brief details below and we will contact you with a quotation.

You

Salutation *	Please Select Mr Mrs Ms Miss Dr
Forename *
Surname *
BCA Member *	Please Select Yes No
Clinic Address *
Clinic Postcode *
Telephone *
Email Address
Mobile
Full Legal Status *	Please select Sole Trader Partnership Ltd Company
Number of years trading *	Please select 1 2 3 4 4+
What prompted you to visit our website? *	Please select BCA Conference Contact Magazine In Touch Insert Mailshot PR Activities Word of mouth

The premises

No of premises to be insured *	Please select 1 2 3 4 5 6 7 8 9 10 10+
No of Surgeries within premises *	Please select 1 2 3 4 5 6 7 8 9 10
Is terrorism cover required? *	Please select Yes No
Premises of standard construction (Brick/stone wall & tile/slate roof) *	Please select Yes No
Is the building occupied by you as a chiropractic clinic? *	Please select Yes No
If no, please give details
Is the building free from flood, heave, landslide and subsidence *	Please select Yes No

General Information

Renewal Date *
Current Premium
Existing provider

Security

Are the premises protected by Alarm *	Please select Yes No
Name of Alarm company *
Alarm signal method *	Please select Bells only BT Redcare Other
Is there a police response *	Please select 1 2 3 None
Do local authority CCTV cameras cover the premises *	Please select Yes No
Are there any enhanced security measures *

Sums Insured

Contents (excl computers) *
Of which, how much is fixed equipment *
Computer Equipment *
Buildings sum insured (rebuild costs)
Tenant's improvements
Loss of rent payable (Annual figure)
Loss of rent payable indemnity period	12 months 18 months 24 months

Loss of Gross Fees / Business Interruption

Annual Practice Income (inc rent receivable) *
Indemnity Period *	Please select 12 months 18 months 24 months

Claims

Have you suffered any claims in the last 5 years *	Please select Yes No
If yes, please give details of dates, incident and costs

*Denotes compulsory field

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