| * Proposer |
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* Business name |
A value is required. |
| Date of Birth |
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* E-mail address |
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| * Contact Phone |
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Alternative Phone |
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| Business Address |
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Town |
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| County |
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* Post Code |
A value is required. |
| Best quote so far? £ |
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Renewal/Start Date Required |
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| * Have you ever been refused insurance, had a policy cancelled or any special terms imposed? |
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| * Have you any CCJ's, bankruptcy orders, previous insolvent companies or criminal convictions? |
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| Do you trade from Home? |
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Are you a Ltd Company? |
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| What trade or trades do you do? |
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What year did this business start trading? |
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| What is your estimated annual turnover? |
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| How many years trade experience do you have? |
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Do you do any work outside of the UK? |
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| How many manual staff? |
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How many clerical staff? |
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| How many manual directors or proprietors? |
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How many clerical directors or proprietors? |
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| What is your annual wagebill for manual staff? (including directors) |
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What is your annual wagebill for clerical staff? (including directors) |
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| How many labour only sub contractors do you use? |
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How much do you spend on labour only sub contractors? |
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| How much do you spend on bona fide sub contractor companies? |
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Do you require temporary employers' liability cover? |
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| Do you do any height work? |
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Do you use any hazardous chemicals? |
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| Do you do any depth work? |
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Do you work at any hazardous locations, such as power stations, docks, railways, airports, offshore etc.? |
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| Do you do any heatwork? |
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Employers' liability is provided at a standard level of £10,000,000 |
What level of public liability cover do you require? |
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