| Personal/Company Details |
|
Proposers Name(s): (incl. all partners names if partnership) | |
| Limited Company Name (if applicable): | |
| Trading Name: | |
| Trading Status: | |
| 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 |
| If yes, please provide details: | |
Description of your business activities: (e.g. vehicle sales, mechanical repairs/sevicing, etc.)  | |
Please describe the type of vehicles you work on: (e.g. cars, vans, commercial vehicles over 3.5 ton, etc.) | |
| Where do you trade from? | |
| Do your activities involve the use of heat? | Yes No  |
If yes, please state the type of heat used (e.g. welder) and how frequently it is used: | |
| Trading Experience |
| How many years has your business been trading? | |
| Number of years experience (if different) |
|
| Claims 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: | |