Electricians 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 electricians/electrical contractors only.

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

Personal/Company Details
Proposers Name (incl. all partners names if partnership):
Limited Company Name (if applicable):
Trading Name:
Trading Status:	- - - - - - - - - Please Select - - - - - - - - Sole Trader Partnership Limited Company Limited Liability Partnership (LLP) Unincorporated Association
Occupation/Trade:
Postal 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
If yes, please provide details: (e.g. type of incident, date(s), amounts of bankruptcy, fines, custodial sentence, etc.)
Description of your business activities: (Please describe as fully as possible)
Is your home the base for your business or are you operating from seperate dedicated business premises?	- - Please Select - - Home Business Premises
Is any work undertaken outside of the U.K.?	Please Select Yes No
Do your activities involve the use of heat?	Please Select Yes No
If yes, please state the type of heat used (e.g. blowlamp) and how frequently it is used:	Type Used: Frequency:
Do you carry out any 3 phase work?	Please Select 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 History
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:	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 Liability Cover Required
Public/Product Liability
Public/Product Liability limit of indemnity:	£	1 Million 2 Million 5 Million Not Required
Number of Proprietors/Partners/Co. Directors:
Wages of Proprietors/Partners/Co. Directors:	£
Annual Turnover:	£
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)	£
Employers Liability (Compulsory by Law if you employ staff)
Is Employers Liability Cover Required?		Please Select Yes No
Number of Clerical/Administrative Employees:		Do not include proprietors, partners or directors
Number of Manual Working Employees:		Do not include proprietors, partners or directors
Total Annual Wages of Employees:	£
Tools Cover (Optional)
Tools Sum Insured:	£	(£2,500 max sum insured)
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:
Renewal Date (if applicable):		(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.