Company Name:
Company Status:
Contact Name:
Contact Telephone Number:
Mobile Number:
Fax Number:
Email Address:
Address:
Street:
Town:
County:
Postcode:
Website:
Occupations:
Nature of Business:
Business Established:
Are you a member of a Trade Association
Name of Association:
Renewal Date:
In Order to Calculate the Premium we will require the following Information about your company. If this is a new venture or you have not been trading for a full year, please estimate the figures requested from your company projections or your business plan. If you are unsure please contact one of our specialists today 0800 021 4504:
Estimated Annual Turnover:
Estimated Wages and Salaries:
a)Clerical / Management
b) Manual wages paid to:
Employees:
Labour only Subcontractors and self employed hired:
Labour gangers/masters and persons supplied by them
c)Payments to Bonafide Sub Contractors Insurance
Is there a system to check the insurance arrangements of bonafide sub-contractors?
Do you require Cover for hired In Equipment:
Estimated Annual Hiring charges:
Largest single contract value in last 3 years:
Average value of contracts:
What percentage of your work involves the use of heat:
Do you undertake or provide design plans or technical
advice, supervision or inspection
Vessels, dams, docks or harbours:
Refineries or oil, petrol, gas or chemical storage tanks,
chambers or depots:
Bridges, viaducts, towers, steeples, chimney shafts or
blast furnaces
Power stations, nuclear -
Power stations, nuclear installations or establishments
Computers or Computer Rooms
Railway or airside at any airport
Do you undertake any hazardous actrivities?
If Yes please advise what these are:
NOTES: These could include: underpinning, Underground work / Tunnelling, Quarrying/Pile Driving, Demolition, Steel Erection, Scaffolding, Use of Explosives, gages, acids or chemicals, offshore work
Estimate: Annual Turnover For Manual Work -
Do you have a health and safety Policy statement?
Are Full risk assessments carried out & documented?
Employers Liability
Public & products Liability
Contract works - Maximum Contract Price
Hired in Plant - any one item
Hired in Plant - any one occurance
owned Plant (current Market/New Replacement values)
Temporary buildings
Employee tools - Total sum insured
Employee tools - Limit any one employee
Have you made any claims in the last 5 years?