| Details of the Business to be insured |
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| Legal status of the Proposer |
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| Proposer's name in full |
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| Specify any additional trading names other than those listed above |
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| Address of the Business |
| Address Line 1 |
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| Address Line 2 |
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| City |
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| County |
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| Postcode |
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| Further details of the Business to be insured |
| Full Business description |
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| Trade selected |
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| Does the Proposer carry out any activities that are different to the trade selected? |
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| Does the Business trade from any additional locations? |
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| In which year did the Business start trading? (YYYY) |
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| The working procedures for the Business |
| Are the Proposer's ways, works, machinery and plant properly fenced and otherwise in good order and regularly inspected to comply with statutory requirements? |
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| Is smoking allowed on the Business premises (select 'No' if no Business premises)? |
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| Does the proposer have; |
| a) a formal written Health and Safety policy (select 'Yes' if less than 5 employees where this is not required)? |
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| b) a formal safety training plan for employees (if E.L. required)? |
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| c) a documented procedure for high risk activities (if applicable)? |
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| d) a formal documented accident investigation plan? |
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| What percentage of total turnover does this represent for; |
| a) on the premises? |
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| b) away from the premises? |
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| Does the Proposer contract work to any sub-contractor? |
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| Are these contracts with; |
| a) labour only sub-contractors (LOSC)? |
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| b) bona fide sub-contractors (BFSC)? |
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| Does the Proposer require the sub-contractor to carry relevant Employers', Public and Products Liability insurance (at a similar Limit of Indemnity to this proposal) and are satisfied that this insurance is in place? |
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| Does the Proposer or any of its employees carry out any manual work (other than collection and delivery) away from the Business premises? |
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| What percentage of the TOTAL turnover is work carried out at the following locations; |
| a) Private Dwelling HousesPrivate dwelling houses only |
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| b) Commercial BuildingsFlats, Shops, Public Houses, Schools, Restaurants and Offices only |
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| c) Industrial BuildingsFactories, Warehouses, Agricultural, Quarries, Hospitals, Hotels, MOD or Other |
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| Please provide full details of these locations worked at |
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| Does the Proposer or any of its employees engage in any work outside the United Kingdom? |
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| Hazardous Activities |
Does the Proposer or any of its employees use, handle, transport or work in/on any of the following;
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If yes - Provide full details of exposure and the precautions taken?
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| a) radioactive substances or devices? |
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| b) explosive substances? |
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| c) asbestos or silica or material containing these substances? |
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| d) toxic or hazardous chemicals? |
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| e) any materials giving rise to dust or fumes? |
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| f) processes involving a noise level in excess of 85db? |
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| g) demolition? |
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| h) bridges, piers, docks, viaducts, towers, steeples, chimney shafts or blast furnaces? |
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| i) underpinning, pile driving, quarrying, tunnelling or mines? |
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| j) aircraft (or airside work)? |
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| k) ships, boats, hovercraft, docks, wharves, railways, offshore installations, rigs or platforms? |
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| l) heights exceeding 15 metres? |
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| m) depths exceeding 0.5 metres? |
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| n) cranes, cradles, slings or similar apparatus? |
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| Sections of cover required: |
| Employers' Liability? |
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| Public Liability? (This is required on all policies, unless specifically agreed by Underwriters) |
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| Product's Liability? |
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| Does the proposer manufacture , supply or distribute; |
| a) any product used in aircraft, aerospatial device, motor vehicle, hovercraft, or waterbourne craft or marine, motor or aviation purposes? |
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| b) fertilisers, pestcides, fungicides and/or animal feeds? |
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| c) pharmaceutical, medical, cosmetics, beauty aids and/or blood products? |
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| d) chemicals/petrochemicals or any other substance of an explosive, toxic or noxious nature? |
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| e) genetically modified organisms and/or seeds and/or products containing genetically modified organisms? |
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| f) tobacco products? |
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| g) asbestos products? |
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| h) tanning machines, toys and/or mobile telecommunication equipment? |
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| i) firearms and munitions? |
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| Estimated turnover for the period of insurance proposed, split by territory: |
| U.K. |
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| U.K. - Bona fide sub-contractors (BFSC) |
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| Other European Union |
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| U.S.A. and/or Canada |
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| Other |
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| Limits of Indemnity required: |
| Employers' Liability |
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| Public Liability |
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| Product's Liability |
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| Third party property damage excess required: |
| Excess for each and every event |
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| Choose browse to upload any information you may wish to scan and send us (e.g.claims history, motor fleet schedules, policy documentation) |
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Notes for underwriter
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