Has the proposer or any person named on this policy been refused insurance or had a policy cancelled by an insurance company, or had any special terms imposed?
Has the proposer or any person named on this policy ever had a county court judgement against them?
Has the proposer, director or partner of the business or practice ever been declared bankrupt?
Has any proposer, director, partner of the business/practice or person named on this policy had any convictions, criminal offences or prosecutions pending other than motor offences?
NO
Title
Proposer (put 'business' in not an individual)
Contact Name
Date Of Birth (dd/mm/yyyy)
Business Name
Email
Contact Phone Number
Other Phone Number
Business Address
Number or Name
Street
Town or City
County
Postcode
Years trading at business address
Please provide the following information, If the particular question doesn't apply to you and your business; simply leave it blank.
Renewal / Start Date Required (dd/mm/yyyy)
Do you trade from home Select Yes No
Is the company LTD Select Yes No
Company Trade
Year business started trading
Your Occupation
Estimated annual turnover (£)
Trade experience (years)
Work outside of the UK Select No Yes - Within the EU Yes - Outside the EU Yes - Both
How many manual staff
How many clerical staff
How many manual directors or proprietors
How many clerical directors or proprietors
Annual wage bill for manual staff inc. Directors (£)
Annual wage bill for clerical staff inc. Directors (£)
How many labour only Sub-contractors used
Spend on labour only Sub-contractors (£)
Spend on bona fide Sub-contractor companies (£)
Temporary employers' liability cover required Select Yes Yes
Does the trade involve height work Select No Yes - Up to 4m Yes - Up to 10m Yes - Up to 15m Yes - Up to 25m Yes - Above 25m
Use of hazardous chemicals Select Yes No
Does the trade involve depth work Select No Yes - Up to 1m Yes - Up to 2m Yes - Up to 3m Yes - more than 3m
Work in hazardous locations (power stations, offshore, airports etc) Select Yes No
Does the trade involve heat work Select No Yes - Up to 10% Yes - Up to 20% Yes - Up to 50% Yes - Above 50%
*Note* Employers' liability is provided at a standard level of £10,000,000
What level of public liability cover do you require Select £1,000,000 £2,000,000 £5,000,000 More than £5m
Please inform us of anything else we should know.
Please tell us the best quote you have received so far and we will try and beat it
Policy Quote Amount (£)
We will be in contact regarding your insurance quote within 24 hours to confirm details and progress the policy.
