For UK Customers Only

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

This form is designed to for individuals/companies requiring contractors all risks insurance whilst working at a contract site. In addition to public & employers liability cover, the policy can be extended to include cover for contract works, own plant, hired-in plant, etc. For any other type of insurance, please either go to our business insurance page or our home page.

If you have any problems with completing this form, please phone us on 08453 455 855 for assistance. Regrettably, we are unable to quote for risks based in Ireland.

General Contact Information
Proposers Name (incl. partners names if partnership):
Trading Name:
Trading Status:	- - - - - - Please Select - - - - - - Sole Proprietor Partnership Ltd. Company Limited Liability Partnership
Trading Address:
Postcode:
Daytime 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
Trade / Work Undertaken
Description of your business activities: (Please describe as fully as possible)
Please state all types of properties worked on: (e.g. private dwelling houses, shops, offices, factories, etc.)
Hazardous Locations / Work Outside UK
Is work carried out at any hazardous locations? (e.g. railways, motorways, bridges, viaducts, nuclear installations, refineries, airports, quarries, mines, ships, docks, piers, towers, steeples, offshore installations, etc.)	Please Select No Yes
If yes, please state type of location(s) and the percentage of work spent at the location(s):
Is any work undertaken outside the UK?	Please Select No Yes
Trading Experience
How many years has the business been trading?	0 1 2 3 4 5 6 7 8 9 10 11+
Number of years experience (if different)	0 1 2 3 4 5 6 7 8 9 10 11+
Depth / Height Work
Please state maximum depth worked (metres):
Please state maximum height worked (metres):
Heat Details
Do your activities involve the use of heat?	Please Select No Yes
If yes, please state the type used and the percentage of work that involves the use of heat:	Type used: %age of work:
Health & Safety
Have you, or any other Partner or Director ever been prosecuted under the Health & Safety at Work Act?	Please Select No Yes
Do you have an up to date Health & Safety Policy tailored to your activities?	Please Select No Yes
Do you carry out a full Health & Safety Risk Assessment at the contract site before commencing work?	Please Select No Yes
Do you work with asbestos, silica, explosives or any other substances hazardous to health?	Please Select No Yes
Fire / Security Details
Do you adhere to the Joint Code of Practice for Fire Prevention on Construction Sites? (applicable to contracts of approx. £2M and over)	Please Select No Yes N/A
If yes, are Fire Safety Co-ordinators appointed and fire safety plans prepared?	Please Select No Yes
Do you erect full site perimeter fencing and boarding at the contract site?	Please Select No Yes
Claims History
Has there been any claims in the last 5 years?	Please Select No Yes
If yes, please provide details:	Date of claim 1: Cost of claim 1:£ How claim occurred? ----- Date of claim 2: Cost of claim 2:£ How claim occurred? ----- Date of claim 3: Cost of claim 3:£ How claim occurred? ----- Unfortunately, we are unable to provide a quotation if you are exceeding 3 claims. -----
Turnover
Estimated turnover for the next 12 months (£'s): (Please be as accurate as possible, as an over estimation will increase the premium to be quoted)
Builders Only
If your trade or business is builder, please state the percentage split of your work:
New Construction up to 20m height:	%
New Construction up to 10m height:	%
General Building: (alteration, maintenance, repairs, etc.)	%
Other Building Work (please describe)	%
Total:	100%

Details of Cover Required
Public/Product Liability Cover
Is Public/Product Liability required?	Please Select No Yes
Limit of indemnity required:	Please Select £1 Million £2 Million £5 Million Not Required
	Manual Principals	Non-Manual/Clerical Principals
Number of Principals/Company Directors:
Wages of Principals/Company Directors (£'s):
Annual payments to Bona- Fide Sub-Contractors if used (£'s): (BFSC's are sub-contractors who supply their own materials on site and hold their own insurance)
Employers Liability Cover
Is Employers Liability required?	Please Select No Yes
	Manual Workers	Non-Manual/Clerical Workers
No. of Employees/Labour Only Subcontractors: (Do not include proprietors, partners and directors)
Annual Wages of Employees/L.O. Subcontractors (£'s):
Contract Works
Do you require cover for Contract Works?	Please Select No Yes
If yes, please state maximum contract value (£'s):
If yes, please state maximum length of any one contract (e.g. 6 months, etc.):
Own Plant
Do you require cover for Own Plant?	Please Select No Yes
If yes, please state the total value of your Own Plant, Tools & Equipment required to be covered whilst working on site (£'s):
Hired-In Plant
Do you require cover for Hired-In Plant?	Please Select No Yes
If yes, please state annual charges incurred (£'s):
If yes, state the maximum value of any one item of hired-in plant (£'s):
Employees' Tools
Do you require cover for employees' tools?	Please Select No Yes
If yes, please state how much cover you require for your employee's tools (£'s):
Additional Information/Cover (optional)
Details of any additional information / cover:

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 Contractors Quotation button and we will contact you shortly with a quotation.