Specialist Divisions MFL Science & Technology Research and Development facility quotation application

Research and Development facility quotation application

Please complete the following short series of questions.

Reminder: Ensure you’ve a copy of your business plan or business summary to upload with your application.

Business name*
Contact name*
Prefix First Last Suffix
Telephone number*
Contact e-mail*
Main address site where business will be undertaken*
If you have selected other, please provide the address below
Do you require cover for any other addresses?*
- Yes
- No
If you have selected yes, please provide additional address below
SUMS INSURED - Please provide details of the following:

Buildings (£)
Please provide details of the following:

Computers permanently at the premises (£)
Please provide details of the following:

Office equipment (£)
Please provide details of the following:

Laboratory Equipment (£)
Please provide details of the following:

Laptops (Anywhere in the world) (£)
Please provide details of the following:

Any other equipment used away from the premises (£)
Please provide details of the following:

Any other contents (£)
Please provide details of the following:

Increased costs of working (please select) (£)
Please provide details of the following:

Public/product liability (£)
Please provide details of the following:

Financial/people/activities income (Excluding external finance) (£)
Please provide details of the following:

Amount of external finance (£)
Please provide brief details of the source(s) of finances below (where applicable)
When do you anticipate making commercial sales?
Total number of employees in the next 12 months
Total annual wage roll (£)
Please estimate what percentage of this wage roll relates purely to clerical activities (%)
Briefly describe what process you will undertake in your work, for example; details of any heating processes, mixing, use of pressure, vacuum, etc.
If applicable, what bio hazard classifications apply to your business?
Do you use any substances which are known to be hazardous to human health, the environment or are subject to any regulatory controls?
- Yes
- No
If you've answered yes, provide brief details below
Please attach a business plan. Alternatively, please attach a brief summary/overview of your business (Documents should be in Word (doc), pdf or Excel (xls, xlt, xlm) only).*
Accepted file types: doc, docx, pdf, xls, xlt, xlm, Max. file size: 5 MB.

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