Personal/Company Details
Proposers Name(s):(incl. all partners names if partnership)
Limited Company Name:(if applicable)
Trading Name:
Trading Status:
- - - - - - Please Select - - - - -
Sole Trader
Partnership
Limited Company
Limited Liability Partnership
Unincorporated Association
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:(Please describe as fully as possible)
Do your activities include the erection of steel frame buildings? Yes No
Is your home the base for your business or are you operating from separate dedicated business premises?
- - Please Select - -
Home
Business Premises
Is any work undertaken outside of the U.K.? Yes No
If yes, please provide details:(i.e. area, percentage of time outside UK)
Please state the percentage of time using heat? %
Please state the type of heat used(e.g. flame cutting, welder, etc.) :
Please state the maximum height you would work from ground level: metres
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:
Trading Experience
How many years has your business been trading?
Please Select
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1 Year
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28 Years
29 Years
30 Years
30+ Years
Number of years experience (if different)
Please Select
0 Years
1 Year
2 Years
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26 Years
27 Years
28 Years
29 Years
30 Years
30+ Years
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: