Cleaners Liability Insurance Quotation 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 cleaners / cleaning contractors only. Please note that we are unable to quote for customers based in Ireland.

If you have any problems with completing this form, please phone us on 08453 455 855 for assistance.

Personal/Company Details
Proposers Name(s) (incl. all partners names if partnership):
Ltd. Company Name (if applicable):
Trading Name:
Trading Status:	- - - - - - - Please Select - - - - - - Sole Proprietor Partnership Limited Company Limited Liability Partnership
Trade / Business:
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
Description of your business activities: (Please describe as fully as possible)
Please give details of any Trade Association you are a member of: (including membership number)
Is your home the base for your business or are you operating from separate dedicated business premises?	- - Please Select - - Home Business Premises
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
Work Activities
Please state the percentage split of your contracts:
Private dwelling houses and flats:	%
Shops / Offices / Pubs:	%
Schools / Hospitals:	%
Factory cleaning, excl. machinery:	%
Carpet / Upholstery cleaning:	%
Builders cleans (internal only):	%
Pressure washing without use of chemicals:	%
Other Cleaning Work (please specify):	%
Total:	100%
Hazardous Cleaning Activities
Do you carry out work at:
Any hazardous locations?	Please Select Yes No
Involving stone, tank or boiler cleaning or use of high-pressure equipment?	Please Select Yes No
Involving the cleaning of business computers?	Please Select Yes No
If yes, please provide details including type & method of work, equipment and chemicals used, maximum PSI etc.:
Health & Safety / Claims Experience
Do you have a written Health & Safety Policy?	Please Select Yes No N/A
Have you or any other partner or director ever been prosecuted under the Health & Safety Regulations or Factory Acts?	Please Select Yes No
Have you or any other partner or director suffered any loss or had any claims made against you 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 state your annual payments to Bona-Fide Sub-Contractors (if used): (BFSC's are sub-contractors who supply their own materials on site and hold their own insurance)	£
Turnover
Do you manufacture or supply cleaning consumables/equipment or janitorial products?		Please Select Yes No
Estimated Annual Turnover for next 12 months: (excluding sales of cleaning/janitorial products)	£
Estimated Turnover in respect of cleaning/ janitorial products sold/supplied only:	£
Additional / Optional Covers
The following covers are available at additional premium for businesses with 3 or more employees:
Do you require cover for damage to property / item(s) being cleaned?		Please Select Yes No N/A
Do you require cover for treatment risks? (Damage to carpets, soft furnishings, etc. caused during cleaning using cleaning chemicals)		Please Select Yes No N/A
Do you require cover for loss of keys?		Please Select Yes No N/A
Details Of Current / Previous Policies
Current Annual Premium:	£	This may help us to get you a better quote
Current/Previous Insurer:
Renewal Date:		(e.g. dd/mm/yyyy)

Request Quotation

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