Business Name:
Please State if Limited Company:
Contact Name (inc Title):
Business Address:
Contact Number:
E-mail Address:
Renewal Date:
Name of Existing Insurers:
Target Premium (£):
Date Business Established:
Description of Business Activities:
Maximum Value Any One Contract (£):
Maximum Period Any One Contract (months):
Sum Insureds:
Own Plant & Equipment (£):
Max Value Any One Item of Hired in Plant (£):
Estimated Annual Hire Charges (£):
Estimated Annual Turnover (£):
Details of Any Work Outside of U.K.:
Please Give Details of ALL and ANY Claims/Losses You Have Suffered In The Past 5 Years:(please advise date(s), cost(s) and circumstances)
Have You Ever Had an Insurance Policy Cancelled or Special Terms Imposed?
Any Additional Information/Comments:
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