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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: | |
Occupation/Trade: | |
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. |
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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/reason for conviction(s), date(s) of conviction(s), details of any fines and/or community service (if applicable), length of custodial sentence(s) (if applicable),etc.) | |
Has any insurer ever refused renewal, declined or cancelled cover or imposed any special terms? | Yes No |
If yes, please provide details: (e.g. details/reason for 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 order or improvement order by the Health & Safety Executive? | Yes No |
If yes, please provide details: (e.g. date of prosecution(s)/prohibition order, details of offence(s), details of any fines/action taken (if applicable), 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: (Please describe as fully as possible including a percentage split between each activity, if you carry out more than one activity. | |
Please provide a percentage split in respect of the following work activities (Must add up to 100%): |
Solar Photovoltaic (PV) Contracts: | % |
Solar Thermal contracts: | % |
Ground Source/Air Source Heat Pump contracts: (domestic only) | % |
Ground Source/Air Source Heat Pump contracts: (all contracts other than domestic) | % |
Wind Energy/Turbine contracts: | % |
Home Insulation contracts: | % |
Biomass contracts: | % |
Heating and/or Plumbing: | % |
Electrical Contracting: | % |
All other work (state details of other work below if applicable)
| % |
Total: | 100% |
Type of Premises / Locations Worked At (away from your own premises) |
Please confirm the percentage of your work carried out at the following premises: |
Private dwelling houses and flats? | % |
Commercial buildings (e.g. shops, offices, etc.)? | % |
Industrial buildings (e.g. factories, units, etc.)? | % |
All other premises/locations (state below if applicable)?
| % |
Total: | 100% |
Is work carried out at any hazardous locations? (These can include, but are not limited to; offshore installations, railways, motorways, bridges, viaducts, power stations, nuclear installations, oil, gas or petrochemical refineries, aircraft/airports/airside, quarries, mines, watercraft/ships, docks, harbours, piers, towers, steeples, hospitals and other medical facilities.) | Yes No |
If yes, please state type of location(s) and the percentage of work spent at the location(s): | |
Is any work undertaken outside of the U.K.? | Yes No |
If yes, please provide details: (i.e. area / country of work and percentage of turnover this represents) | |
Trading Experience |
How many years has your business been trading? | year(s) |
Number of years previous experience in this trade: (A minimum of 3 years previous experience is required if you have 0 years trading) | year(s)
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Trade Associations |
Is your company a member of any trade association? (discounts may be available if you are member of a trade association) | Yes No |
If yes, please provide details of trade association(s): | |
Hazardous Work Details |
Do you or your employees work with asbestos, silica, or any other hazardous substances? | Yes No |
If yes, please provide details: (i.e. type of hazardous substance and percentage of turnover this represents) | |
Do you or your employees use slings, cradles, bosuns chairs, abseiling equipment or tower cranes? (cherry pickers and mobile access platforms are acceptable) | Yes No |
If yes, please provide details of equipment used: | |
Scaffolding |
Do you use a scaffolding (bona-fide) sub-contractor? | Yes No |
Do you ever erect your own scaffolding? | Yes No |
If yes, type of scaffolding (e.g. tower, tied, etc.): | |
How often do you erect your own scaffolding? | |
What is the maximum height of the scaffolding you erect for your own use? | metre(s) |
Professional Services |
Do you provide professional services for a fee such as advice/consultancy, design, testing, inspection and certification? | Yes No |
Heat Use |
Do your activities involve the use of heat? (e.g. blow lamps, blow torches, welding equipment, heat guns, etc.) | Yes No |
Please state the type(s) of heat used: (e.g. blow lamp, welding equipment, heat guns, etc.) | |
Please confirm the percentage of time it is used: (e.g. 5%) | |
Height / Depth Worked |
Please state the maximum height worked: | metres |
If any work is above 15 metres, please provide details: (e.g. type(s) of contract(s)/work undertaken, and percentage of turnover that this work represents) | |
Please confirm the maximum depth you would dig: | metres |
Health & Safety |
Do you have a written Health & Safety policy in force which is reviewed regularly and distributed to employees? | Yes No |
Do you carry out a full Health & Safety Risk Assessment at the contract site before commencing work? | Yes No |
Are written Method Statements prepared for each contract? | Yes No |
Is Health & Safety training given to employees and is the training recorded? | Yes No |
Do you supply and enforce use of Personal Protective Equipment (PPE) where required? | Yes No |
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 |
Claim 1. |
Date of Loss: | |
Cause of Loss: | |
Circumstances of the Loss: | |
Total Cost of Loss (£'s): (including any amounts paid or outstanding) | |
Status of Claim: | Settled Claim Still Pending |
Do you wish to add another claim? | Yes No |
Claim 2. |
Date of Loss: | |
Cause of Loss: | |
Circumstances of the Loss: | |
Total Cost of Loss (£'s): (including any amounts paid or outstanding) | |
Status of Claim: | Settled Claim Still Pending |
Do you wish to add another claim? | Yes No |
Regrettably we will be unable to provide a quotation if you have had more than 2 claims. |
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Public/Product Liability |
Public/Product Liability limit of indemnity: | |
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| | Manual Principals | | Non-Manual/ Clerical Principals |
Number of Proprietors/Partners/Co. Directors: | No. | | No. | |
Annual Wages of Proprietors/Partners/Co. Directors: | | | | |
Please confirm your annual payments to Bona Fide Sub-Contractors (BFSC's) (if used): (BFSC's are sub-contractors who supply their own equipment / materials on site and hold their own liability insurance (e.g. scaffolders, electricians, etc.)) | |
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Employers' Liability (Compulsory by Law if you have employees or use labour only sub-contractors) |
Is Employers' Liability Cover Required? (£10M standard limit of indemnity) | |
| | Manual Workers | | Non-Manual/ Clerical Workers |
Number of Employees/Labour Only Sub-Contractors: (Do not include proprietors, partners or directors) | No. | | No. | |
Annual Wages of Own Employees: | | | | |
Annual Payments to Labour Only Sub-Contractors: (LOSC's are sub-contractors who supply labour only and work under your supervision) | | |
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Employers' Reference Number (optional) |
Employers' Reference Number (ERN) (if available): | | (e.g. 123/AB12345 or 'Exempt') |
Turnover |
Estimated Annual Turnover for next 12 months: | |
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Tools Cover (optional)
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Is Tools cover required? | Yes No |
Tools Sum Insured: | | £500 to £5K maximum |
Professional Indemnity (optional) |
Is Professional Indemnity cover required? (Recommended if you provide any advice, design or specification) | Yes No |
Limit of indemnity required: | |
Does more than 10% of your turnover relate to pure advice, design, specification, surveying, or consultation carried out for a fee? | Yes No |
If yes, please confirm percentage of turnover? | |
Have you, or your company previously held professional indemnity insurance? | Yes No |
If yes, do you currently have a retroactive date for your current policy? | Yes No |
If yes, please provide the retroactive date of your current policy: | |
Are you aware of any circumstances or incidents in the last 6 years that could give rise to a professional indemnity claim being made against you? | Yes No |
If yes, please provide details: | |
Directors & Officers Cover (optional) |
Is Directors and Officers cover required? (Cover for any 'wrongful act' of a director of a limited company) | Yes No |
Please confirm the limit of indemnity required: | | |
Can you confirm that the company is domiciled in the UK; is privately held; has not raised any funds from external parties; has been in operation for more than 12 months; has its financial statements prepared by a qualified accountant, shows a profit and are not subject to any concerns by the auditors; derives at least 50% of all its turnover from clients within the UK and EU; has not acquired any companies which have increased its total assets by 50% or more; and has no mergers or acquisitions planned and has not had any claims made against it or its directors and is not aware of any circumstances that could give rise to such claim? | Yes No |
If no, details: | |
Business Legal Expenses Cover (optional) |
Is Business Legal Expenses cover required? (£100,000 cover for legal disputes, employment disputes, tax investigations, etc.) | Yes No |
Legal Expenses Limit of Indemnity: | | |
Has the business and/or its directors been involved in any legal dispute, tax investigation or any other court or tribunal action in the last 5 years? | Yes No |
Please provide details of the dispute including dates: | |
Additional Information
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Details of any additional information you wish to disclose or any other cover required: | |
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. |
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Cover Start Date / Renewal Date: | |
Current Annual Premium / Best Quote: | This may help us to get you a better quote |
Name of Current / Previous Insurer: | e.g. Aviva, AXA, Allianz, QBE, RSA, Zurich, etc. |