Asbestos Removal Liability Insurance Quote Form

Please insert your details below and one of our commercial advisers will contact you shortly with a liability insurance quotation.

This form is designed for quotes for Public/Employers Liability Insurance for asbestos removal contractors only. Please note that we are only to quote for customers based in mainland UK.

If you have any problems with completing this form, please phone us on 01623 641 386 for assistance.

Personal/Company Details
Proposers Name(s) (incl. all partners names if partnership):
Limited Company Name (if operating as a Ltd. Company):
Trading Name:
Trading Status:	- - - - - - Please Select - - - - - Sole Proprietor Partnership Limited Company Limited Liability Partnership
Occupation/Trade:
Postal Address:
Postcode:
Daytime Telephone Number:
Mobile Telephone Number:
E-Mail Address:
General Information
Have you, or any other partner or director ever been convicted of any offences, been declared bankrupt/ insolvent or had any insurance refused or cancelled?	Yes     No
Have you, or any other partner or director ever been prosecuted under the Factories Act and/or the Health & Safety At Work Act?	Yes     No
Business Activities
Description of your business activities: (Please describe as fully as possible)
Type Of Contracts
Please state the percentage split of your contracts:
Domestic/Residential:	%
Commercial:	%
Industrial:	%
Total:	100%
Are you a member of any trade association?	Yes     No
If yes, please specify the name and your membership number:
Is any work undertaken outside of the U.K.?	Yes     No
Years Trading/Experience
How many years has your business been trading?	Please Select 0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years 20+ Years
Number of years experience (if different)	Please Select 0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years 20+ Years
Claims Experience
Have you suffered any loss or incidents which would have given rise to a claim in the last 5 years?	Please Select Yes No
If yes, please provide details:	Date of claim: Cost of claim:£ Details of claim: ---------------------------- Date of claim: Cost of claim:£ Details of claim: ---------------------------- Regrettably, if you have more than 2 claims, we will be unable to provide you with a quotation.

Details Of Cover Required
Public/Product Liability
Public/Product Liability limit of indemnity:	£	1 Million 2 Million 5 Million Not Required
		Manual Principals		Non-Manual/Clerical Principals
Number of Proprietors/Partners/Co. Directors:	No.		No.
Annual Wages of Proprietors/Partners/Co. Directors:	£		£
Employers' Liability (Compulsory by Law if you employ staff)
Is Employers' Liability Cover Required?		Please Select Yes No
		Manual Employees		Non-Manual/Clerical Employees
Number of Employees: (Do not include proprietors, partners or directors)	No.		No.
Total Annual Wages of Employees:	£		£
Please confirm the percentage of time employees spend on asbestos removal contracts:		%
Please confirm your annual payments to Labour-Only Sub-Contractors (if used):	£
Please confirm your annual payments to Bona-Fide Sub-Contractors (if used): (BFSC's are subcontractors with their own insurance)	£
Turnover
Estimated Annual Turnover for forthcoming year:	£
Annual Turnover for the previous 12 months:	£
Additional Information
Any additional information / cover required:

Details Of Current / Previous Policies
Current Annual Premium:	£	This may help us to get you a better quote
Current/Previous Insurer:
Liability Renewal Date (if applicable):		(dd/mm/yyyy)

Request Quotation

Disclosure
Please ensure that all the information you have provided is correct, then press the Request Asbestos Liability Quotation button and we will contact you shortly with a quotation.