Personal/Company Details Proposers Name
Trading Name:
Occupation:
Trading Status:
- - - Please Select - - -
Sole Trader
Partnership
Ltd. Company
Ltd Liability Partnership
Trading Address:
Postcode:
Daytime Telephone Number:
Mobile 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:
Do you use any hydraulic
Please Select
No
Yes
If yes, please give details of the
Health & Safety
Do you have a written Health
Please Select
No
Yes
Do you have a formal
Please Select
No
Yes
N/A
Is the company a member of the NASC?
Please Select
No
Yes
Trading Experience
How many years has the business been trading?
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 within the last 5 years:
