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pro-indemnity.co.uk

Liability (for more than 6 persons) Quote

1. Name of Proposer:

 Company Trading Title:

 Type of Company:

2. Address of the premises:

 Post Code:

 Tel. Number:

 E-mail :

3. Description of Business: (Occupation & Nature of all Business engaged in)

 

 Percentage of work away from premises

%

 Maximum height level worked (m)

 Maximum depth level worked (m)

 Do you engage in heat work?

 Yes No

 If Yes to heat work, percentage of work away:

%

4. Numbers of years trading:

5. How many Principals / Partners / Directors work manually? :

6. Wages - manual, including partners, principals and directors, but excluding woodworking

£

 Manual woodworking machinists wages

£

 Clerical and non-manual staff wages

£

 Payments to labour-only sub-contractors

£

 Payments to bona-fide sub-contractors

£

7. Annual Turnover

£

8. INSURANCE HISTORY

 

 Have you got previous insurers:

 Yes No

 Name of current insurers (so that we don't approach them!)

 Expiry date of current insurance

 Current premium (if known)

£

 Have you ever been declined, cancelled, refused or special terms:

 Yes No

 If "Yes" please give full details

 Have you had any claims:

 Yes No

If "Yes" please give details below -

 

Date of claim:

What happened:

Total Payment:

1.

2.

3.

4.

Do you require Public Liability?

£

Do you require Products Liability?

£

Do you require Employers Liability?

 Yes No

Do you require tools cover?

£

Do you require contractors all-risks cover?

 Yes No

 If yes, please use the Contractors All Risks form available by clicking here.

Please supply me with an estimate within working days.
(We will attempt to meet the target, but please be aware that
it does require our insurers to respond quickly as well!)

Done

 

Please check your details, and when you are happy that all is correct,
tick the 'Done' box and then click the Submit button above...