1.Your Contact Details

Restaurant Name

County

Your Name

E-mail

Phone Number

2.How much was your insurance premium in;

2015

2016

2017

3.Have you had a claim against you in the past five years?

Yes

No

4.Please elaborate on what the claim was for

5.Did you settle your claim

In court

Out of court

6.What was the claim amount?

7.If you have any other comments or thoughts on this issue, please feel free to share