COMPANY/CONTACT DETAILS
Business Name:
Are you a Limited Company:
Contact Name - Title & Surname:
Contact Name - First Name:
Postcode:
Contact Number:
E-mail Address:
Renewal Date:
Name of Existing Insurers:
Target Premium (£):
Please provide a description of your business activities:
How many years have you been trading?
Have you made any claims or suffered any losses in the past 5 years?
Details of membership of any regulatory body (e.g. CORGI):
LIABILITY COVER
Public Liability Limit of Indemnity:
Employers' Liability Limit of Indemnity:
No of MANUAL Principals/Directors:
No of MANUAL Employees inc. labour only subcontractors:
Estimated annual payments to Bona Fide Subcontractors:
Do you need Temporary Employee insurance cover?
Do you work solely on Private dwelling houses, Offices, Public Houses, Guest houses, hotels and schools?
Maximum Height worked at:
Maximum Depth worked at:
Does your work involve the use of Heat?
If Other, please give details:
STATEMENT OF FACT
Comments
Thank you for completing your details - please press the submit button for a quotation.