Personal/Company Details Proposers Name
Occupation/Trade:
Trading Name:
Trading Status:
Please Select
Sole Trader
Partnership
Limited Company
Trading Address:
Postcode:
Daytime Telephone Number:
E-Mail Address:
General Information
Have you, or any other partner or director ever been
Type of premises worked on
Please state the percentage of work carried out at the following locations:
Private dwelling houses and flats? Commercial buildings? (e.g. shops, offices, etc.) Industrial buildings? (e.g. factories, etc.) All other work? (please state below) Total: 100%
Is work carried out at(i.e. railways, motorways, bridges, viaducts, nuclear installations,
Please Select
No
Yes
If yes, please state the type of locations
Work Activities
Please state the maximum height worked (metres):
Do your activities
Please Select
No
Yes
If yes, please state the type of heat used
Do you work with asbestos?
Please Select
No
Yes
If yes, please provide details:
Do you use Slings or Cradles?
Please Select
No
Yes
If yes, please provide details:
Do you use any other hydraulic
Please Select
No
Yes
If yes, please give details of the
Health & Safety
Do you have a written
Please Select
No
Yes
Do you have a formal
Please Select
No
Yes
N/A
Is your company a member of the NFRC?
Please Select
No
Yes
Trading Experience
How many years has
Number of years experience (if different) :
Please provide details of 2 contracts recently completed:Not applicable if company is a new venture )
Contract 1:e.g. work on private dwelling, church, etc.)
Contract Price/Value (£'s):
Contract 2:
Contract Price/Value (£'s):
Claims History
Details of any claims
