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Security / Fire Protection - Declaration Form

Policy Number *
Insured Name *
Period From
Period To
TurnoverManufacturingInstallation / ServicingRetail Sales
A) Intruder Alarms / Components
B) Fire Alarms / Components
C) Fixed Fire Extinguishers
E) Access Control Systems
F) Locks / Safes
g) Grilles
H) Keyholding
I) Central Stations
J) Guarding
K) Portable Fire Extinguishers
L) Sprinklers
M) Door Supervisors
N) Any Other
Please Specify Details
Total Annual Turnover Declared
Wageroll (including labour only subcontractors)
Number of EmployeesWageroll
a) Clerical & Non-Manual Staff
b) Installation / Servicing / Guarding etc.
Total Annual Wageroll
Email Address - *
This email address will be used for correspondence regarding this On-Line form and for no other purpose.
Privacy Statement Fees and Charges Terms and Conditions Capital Cover Group Ltd t/a Brennan Insurances is regulated by the Central Bank of Ireland