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| Your name |
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| E-mail address |
- important information about us will be sent to
this address. |
| Home
Address |
Postcode |
| Trading
Address |
Postcode |
| Trade or
Business Description (Include main business and any
ancillary/ part time work) |
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| Trading
Name |
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| How
many years have you been conducting business or trade in
this name?
How many years
experience do you have in this type of business overall?
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What
date and time would you like insurance cover to commence?
(No cover is in force until the proposal has been
accepted, arrangements made to pay the insurance premium, and
confirmation sent by us)
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| CLAIMS |
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Have
you claimed on a Liability insurance policy in the last 5
years? If so provide details
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| EMPLOYERS
LIABILITY |
(Compulsory
for Limited Liability Companies) |
| Do
you require cover? |
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If
you are NOT a limited company do you require employers
liability insurance cover for working partners?
(If 'Yes' your drawings
should be included in the wages estimate section below) |
| HEALTH
& SAFETY |
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| Are
your employees/ have your employees been exposed to
asbestos? If Yes give details |
Do
you and will you always carry out risk assessments
specific to the task
before commencing work and before any amendments? If No give details |
| Do
you have a written health and safety policy If No give details |
Do
you and will you always prepare written method statements
specific
to the task before commencing work and before any
amendments? If No give details |
Do
you ensure the use of protective equipment is enforced and
a
formal record kept of such equipment supplied to
workforce? If No give details |
If
Necessary give details
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| TRADE
CATEGORIES |
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| Wages
split between different types of work undertaken (please
split into categories). Please also indicate the MAXIMUM
number of employees at any time during the proposed period
of insurance within each category. Please include clerical
work for this section.
Your insurance premium will be
based on the estimates you provide. You also have to
declare the actual figures at the end of the period of
insurance. If the actual figures are more than you
estimated an additional premium may be payable.
(link to turnover table) If you do NOT complete the
table below we cannot give you a quote for Employers Liability.
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|
Sub-contractors
and the Self Employed
Labour-only
subcontractors, self employed people, people hired or
borrowed by you or embedded in your business are
considered employees if they are working for you and under
your control. You must declare their wages and the number
of people in your employee estimates above.
Other
contractors who are not Employees ('bona-fide'
sub-contractors)
If they
are not working directly for you and not
under your control and they have their own
insurance cover then we do not charge for them under the
Employers Liability Section. Therefore you should not
declare their wages and the number of people in the
employee estimates above.
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PUBLIC AND PRODUCTS LIABILITY INSURANCE
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What level of cover do
you require?
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Do you require cover for
Products and completed works?
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Do you
maintain your full rights of recourse against any manufacturer
or supplier from whom
you obtain any product or anything which is incorporated
into your products If NO give details
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Do all of your products
comply with CE / BS standardsIf NO give details
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Are any of your products
intended to be used in the structure, machinery or
controls
of any aircraft, other aerial device, hovercraft, offshore
installation/rig/ platform If YES give details
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Do your products include
any pharaceuticals, alternative medicines, health
products, dietary
supplements, medical products, blood products, cosmetics
or beauty aids If YES give details
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Do your products include
any industrial or agricultural chemicals If YES give details
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Do your products include
any firearms, munitions,
explosives, fireworks or other pyrotechnics? If YES give details
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If NECESSARY give details
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FINANCIAL LOSS COVER
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Do you require cover for
financial loss
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WORK OVERSEAS AND
EXPORTS
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If you do work outside
or export products outside of England, Scotland, Wales,
Northern Ireland, Isle of Man and the Channel Islands
please indicate the split of turnover between the
following territories
UK
Other EUUSA/
Canada rest
of world (make
sure the total is 100!)
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If you import products
or materials to be incorporated into your products from
outside of England, Scotland, Wales, Northern Ireland,
Isle of Man and the Channel Islands please indicate the
split of turnover between the following territories
UK
Other EUUSA/
Canada rest
of world (make
sure the total is 100!)
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TURNOVER/
NUMBER OF PEOPLE BY TRADE
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Turnover
and maximum number of people estimates split between the
various activities of the business
IF YOUR
BUSINESS INVOLVES MANUAL WORK
When
considering the number of people please include manual
working directors, manual working partners and
proprietors, manual work employees and labour only
subcontractors. You do NOT need to include people who only
to clerical work in this section.
IF YOUR
BUSINESS INVOLVES PURELY CLERICAL WORK
Please
include clerical workers in this section
TURNOVER:
WE define turnover as the amount of money taken for the
activities of the business during the period of insurance
EXCLUDING VAT and excluding payments made to sub
contractors who are not employees. The table below should
have the SAME categories as the one used for Wages - see
here. If
you do NOT complete the table below we cannot give any quote for Public
Liability Insurance
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