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Cleaners Liability Insurance Quotation Form

For UK Customers Only

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.

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

Personal/Company Details

Proposer's Full Name(s):
(enter sole trader's name or all partner's names if a partnership)
Limited Company Name:
(if operating as a limited company)
Trading Name/Trading As:
(if different to the above)
Trading Status:
Business Address:
Postcode:
Daytime Telephone Number:
*E-Mail Address:
*Please note that your email address will only be used to provide you with your quote and not for any other marketing purposes.
General Information

Have you, or any other partner or director
ever been convicted of or charged (but not yet tried)
with any criminal offences other than a motoring offence?
Yes     No
If yes, please provide details:
(e.g. type of conviction(s),
date(s) of conviction(s),
details of any fines and/or length of custodial sentence(s))
Has any insurer ever refused renewal,
declined/cancelled cover or imposed any special terms?
Yes     No
If yes, please provide details:
(e.g. details of any insurance refused/
cancelled/special terms imposed, etc.)
Have you, or any other partner or director ever had any County Court Judgements (CCJ's) / sheriff decrees / IVA's or ever been declared bankrupt, or involved in a company which has become insolvent or which has gone into liquidation, receivership or administration?Yes     No
If yes, please provide details:
(e.g. date(s) of bankruptcy/insolvency/CCJ/IVA,
amount of bankruptcy/insolvency/CCJ/IVA (£'s),
date bankruptcy discharged / date CCJ/IVA settled,
circumstances of bankruptcy/insolvency/CCJ/IVA, etc.)

Please note we are unable to provide a quote if your bankruptcy
is not discharged or your CCJ / IVA remains outstanding or unsettled.

Have you, or any other partner or director
ever been prosecuted or served a prohibition
or improvement order by the Health & Safety Executive?
Yes     No
If yes, please provide details:
(e.g. date of prosecution(s),
details of offence(s), etc.)
Have you, or any other partner or director ever been the subject of a recovery action from HM Customs and Excise or the Inland Revenue?Yes     No
If yes, please provide details:
(i.e. name of person or business subject to recovery action,
date of recovery action,
and reason for the recovery action)
Business Activities
Description of your work activities: help
(Please describe as fully as possible)
Are you a member of any trade association?Yes     No
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?
Is any work undertaken outside of the U.K.?Yes     No
If yes, please provide details:
(i.e. area and percentage of time outside UK)
Years Trading / Experience
How many years has your business been trading?
Number of years experience (if different)
Height Details
Please state the maximum height you work to: metres
Do you use any slings, harnesses or cradles?Yes     No
If yes, please provide details:
Work Locations
What percentage of your work is carried out at the following locations:
Private Dwelling Houses and Flats: %
Commercial Buildings (shops, offices, etc.): %
Pubs, Hotels and Schools: %
Hospitals: %
Industrial Buildings (factories, warehouses, etc.): %
Any Other Locations other than above (please specify):
%
Total:100%
Hazardous Locations
Do you carry out work at any hazardous locations?
(Hazardous locations are generally defined as on or at airports, aeroplanes, oil/petrol/gas or chemical storage tanks, offshore gas or oil installations, gas or chemical works, nuclear processing installations, railways, tunnels, chimney shafts, collieries, docks, gas works, harbours, mines, oil refineries, power stations, dams, ships, steeples, towers, viaducts, quarrys, dams, hospital operating theatres and clean room environments.)
Yes     No   help
Please provide details of hazardous loctions worked at:
Work Activities
Please state the percentage split of your work activities:
Internal Cleaning-Domestic Premises: %
Internal Cleaning-Commercial Premises: %
Internal Cleaning-Industrial Premises: %
Builders Cleans: %
Carpet / Upholstery Cleaning: %
Machinery Cleaning (please state type of machinery below)
%
Window Cleaning (ground level / reach & wash): %
Window Cleaning Up To 10 Metres (ladders, etc.): %
Window Cleaning Over 10 Metres: %
Pressure Washing & Jetting: %
Any Other Work other than above (please specify below)
%
Total:100%
Antiviral Disinfectants
Do your business activities include applying chemical antiviral disinfectants to production areas as fogs or mists?Yes     No
Hazardous Cleaning Activities
Do you carry out work:
(i) In hospital operating
theatres, or clean room environments?
Yes     No
(ii) Involving the removal of
clinical waste, sharps or needles?
Yes     No
(iii) Involving the cleaning or surgical instruments, surgical clothing, or electrical or mechanical medical equipment?Yes     No
(iv) Involving the cleaning of kitchen canopies,
extraction equipment, ducting or grease traps?
Yes     No
(v) Involving stone, tank or boiler
cleaning or use of high-pressure equipment?
Yes     No
If yes, please provide details including type & method of work, equipment and chemicals used, maximum PSI etc.:
(vi) Involving the use of pressure washing
equipment at a pressure greater than 2,000 psi?
Yes     No
If yes, please provide details including type & method of work, and the maximum PSI used, etc.:
(vii) Involving the cleaning of business computers?Yes     No
(viii) Involving any confined space work?Yes     No
If yes, please provide details:
(incl. percentage of work this represents)
(ix) Any crime scene work?Yes     No
If yes, what percentage of your work?
Health & Safety / Claims Experience
Do you have a written Health & Safety Policy
which is regularly updated and shown to employees?
Yes     No
Claims History / Experience
Have you or any other partner or director suffered any loss or had any claims made against you in the last 5 years?Yes     No
If yes, please provide details:

Details Of Cover Required

Public/Product Liability
Public/Product Liability limit of indemnity:  help
  Manual
Principals
 Non-Manual/
Clerical Principals
Number of Proprietors/Partners/Co. Directors:No. helpNo. help
Annual Wages of Proprietors/Partners/Co. Directors:  
Do you use Bona Fide Sub-Contractors?
(BFSC's are sub-contractors who supply their own equipment/
materials on site and hold their own public & employers' liability insurance)
Yes     No help
If yes, please state your annual
payments to Bona-Fide Sub-Contractors (BFSC's):
   
Type of activities carried out by BFSC's:
Employers' Liability (Compulsory by law if you directly employ staff or labour only sub-contractors)
Is Employers' Liability Cover Required? help
(£10M cover provided as standard)
 
  Manual
Employees
 Non-Manual/
Clerical Employees
Number of Employees/Labour Only Sub Contractors:
(Do not include proprietors, partners or directors)
No. helpNo. help
Total Annual Wages of Employees/LOSC's:  
Employers' Reference Number (optional)
Employers' Reference Number (ERN) (if available): help?
(e.g. 123/AB12345 or 'Exempt')
Turnover
Estimated Annual Turnover for next 12 months: 
Do you manufacture or supply cleaning
consumables/equipment or janitorial products?
 Yes     No
Estimated Turnover in respect of
cleaning/janitorial products sold/supplied only:
 

Additional / Optional Covers

The following optional covers may available at additional premium if required:
Do you require cover for damage
to Property / Item(s) Being Cleaned?
 Yes     No
Do you require cover for Treatment Risks?
(e.g. damage to carpets, soft furnishings, etc.
caused during cleaning using cleaning chemicals)
 Yes     No
Do you require cover for Loss of Keys?
(only applicable if you hold keys for your customers)
 Yes     No
If yes, limit of indemnity required: 
Do you require cover for Business Equipment? Yes     No
Please confirm the sum insured required: 
Is cover required for Fidelity Guarantee?
(i.e. provides cover for theft by employees)
 Yes     No   Help?
If yes, limit of indemnity required: 
Is cover required for Financial Loss?
(i.e. provides cover if a third party suffers financial loss/
business interruption without property damage or injury being
caused, e.g. unable to access business premises, etc.)
 Yes     No   Help?
If yes, limit of indemnity required: 
Do you require Business Legal Expenses Cover? Yes     No   Help?
Limit of indemnity required?: 
Has the business been involved in any
legal disputes, employment disputes
or tax investigations in the last 5 years?
 Yes     No
Do you require Directors and Officers Cover?
(limited companies only)
 Yes     No   Help?
Limit of indemnity required?: 

Additional Information / Cover

Additional Information / Cover
If there is any additional information that
you wish to disclose or cover that you
wish to include, please provide details:
You are required to make a fair presentation of the risk to insurers which means that you are required to disclose every material circumstance which you know or ought to know relating to the risk to be insured. Materially important information is any information that could influence an insurer's decision to accept your risk including the cost of your insurance. Failure to comply with the duty of fair presentation could mean that your policy is void or that insurers are not liable to pay all or part of your claim(s). By submitting this quotation you are confirming that there are no other material facts to disclose other than those shown above.
Details Of Current / Previous Policies

Cover Start Date / Renewal Date: 
Current Annual Premium / Best Quotation: 
This may help us to get you a better quote
Current / Previous Insurer: 
e.g. Aviva, AXA, Allianz, QBE, RSA, Zurich, etc.

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 Cleaners Liability Quotation' button and we will contact you shortly with a quotation.


Estimated Quote Time: 1 to 72 hours