Scaffolders Liability Insurance Quote Form

For UK Customers Only

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

This form is designed for quotes for Scaffolders Public Liability Insurance. Cover can also be extended to include employers' liability insurance if you have employees.

If you require any assistance to complete this form, please phone us on 01623 641386.

Personal/Company Details

Proposers Name (incl. partners names if partnership):
Trading Name:
Occupation:
Trading Status:
Trading 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: (e.g. type of incident, date(s), amounts of bankruptcy, fines, custodial sentence, etc.)
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 any hazardous locations? (i.e. railways, motorways, bridges, viaducts, nuclear installations, refineries, airports, quarries, mines, ships, docks, piers, towers, steeples, offshore installations, etc.)	Yes No
If yes, please state the type of locations and the frequency at these locations:
Work Activities
Please state the maximum height worked:	metres
Health & Safety
Do you have a written Health & Safety statement/policy in force?
Do you have a formal safety training plan for employees?
Is the company a member of the NASC?
Trading Experience
How many years has the business been trading?
Number of years experience (if different):
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
Details of any claims within the last 5 years:	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. -----

Details Of Liability Cover Required

Public Liability
Amount of Public Liability cover required:
Please confirm your annual turnover (£'s):
If any part of the above turnover is for 'hire only' of the scaffolding, please state the percentage below:
Scaffolding hire only:	%
	Manual Principals	Non-Manual/Clerical Principals
Number of Proprietors/Partners/Company Directors:
Wages of Proprietors/Partners/Company Directors (£'s):

Employers' Liability
Is Employers' Liability Required?
	Manual Workers	Non-Manual/Clerical Workers
No. of Employees/Labour Only Subcontractors: (Do not include proprietors, partners and directors)
Annual Wages of Employees (£'s):
Annual payments to Labour- Only Sub-Contractors if used (£'s): (LOSC's are sub-contractors who supply only labour and not materials on site)
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)

Details Of Current / Previous Policies

Current Annual Premium:	This may help us to get you a better quote
Current/Previous Insurer:
Renewal Date:	(e.g. 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 Scaffolders Liability Quotation button and we will contact you shortly with a quotation.

Estimated Quote Time: 0 - 3 working days