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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: | |
Business 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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General Questions |
Have you, or any other partner or director ever been convicted of any criminal offences? | Yes No |
If yes, please provide details: (e.g. type of conviction(s), date(s) of conviction(s), details of any fines, custodial sentence) | |
Have you, or any other partner or director ever had any County Court Judgements (CCJ's) / sheriff decrees / IVA's or 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, amount of bankruptcy/insolvency, date bankruptcy discharged or CCJ/IVA settled, circumstances, 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 had any insurance refused, cancelled or any special terms imposed? | Yes No |
If yes, please provide details: (e.g. date(s) of insurance refused/cancelled, reason for refusal/cancellation, details of any special terms imposed, etc.) | |
Have you, or any other partner or director ever been prosecuted or served a prohibition order by the Health & Safety Executive? | Yes No |
If yes, please provide details: (e.g. date of prosecution(s), details of offence(s), 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) | |
How is the height work accessed (if applicable)? (e.g. cherry pickers, etc.) | |
Do your activities involve the use of rope access? | Yes No |
If yes, please confirm percentage of rope access work: (e.g. 10%) | |
Trade Specific Questions |
Do your activities involve the burning of debris? | Yes No |
If yes, please provide details: (i.e. percentage of turnover involving burning of debris and any fire precautions taken) | |
Do your activities include powerline clearance work? | Yes No |
If yes, please provide details: (i.e. percentage of turnover involving powerlines and any precautions undertaken) | |
Hazardous Locations |
Is any work undertaken in Railway 'Red Zones'? | Yes No |
If yes, please provide details: (i.e. percentage of turnover involving work in 'Red Zones' and any precautions taken) | |
Is any work undertaken in Railway 'Green Zones'? | Yes No |
If yes, please provide details: (i.e. percentage of turnover involving work in 'Green Zones' and any precautions taken) | |
Is work carried out at any other hazardous locations? (e.g. towers, steeples, chimney shafts, blast furnaces, dams, canals, viaducts, bridges, tunnels, aircraft, airports, ships, docks, piers, wharves, sea walls, mines, nuclear or chimcial works, gas works, oil refineries, power stations, bulk oil, petrol, gas or chemical storage tanks, motorways, reservoirs, wells, demolition sites, etc.) | Yes No |
If yes, please provide details: (i.e. please state the location of work, the type of work, and the percentage of turnover this work represents) | |
Work Outside of UK |
Is any work undertaken outside of the U.K.? | Yes No |
If yes, please provide details: (i.e. area/country of work, percentage of work outside UK) | |
Heat Use |
Do your activities involve the use of heat? (other than the burning of debris mentioned above) | Yes No |
If yes, please state the type of heat used (e.g. blowlamp) and percentage use of heat (e.g. 10%): | |
Work at Height / Depth |
Please confirm the maximum height you would work: | metres |
Please confirm the maximum depth you would dig: | metres |
Professional Services |
Do you provide professional services for a fee such as advice/consultancy, design, testing, inspection and certification? | Yes No |
Trading Experience |
How many years has your business been trading? | year(s) |
Number of years experience (if different) (A minimum of 3 years previous experience is required if you have 0 years trading) | year(s)
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Health & Safety |
Do you have a Health & Safety Policy? | Yes No |
Do you keep a record of all training and assessments? | Yes No |
Do you carry out risk assessments for each site you work at? | Yes No |
Do you supply all employees and sub- contractors with Personal Protection Equipment? | Yes No |
Do you comply with PUWER legislation? | Yes No |
Is all your machinery properly guarded and complies with the latest legislation? | Yes No |
Qualifications |
Do you have any qualifications in relation to this work? (Please provide details of your qualifications, or details of your previous experience if no qualifications) | |
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: | |
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Public/Product Liability |
Public/Product Liability limit of indemnity: | | |
| | 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 (if used): (BFSC's are sub-contractors who work without your supervision, provide their own tools/equipment on site and hold their own insurance) | | |
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Employers' Liability (Compulsory by Law if you have employees or use labour only sub-contractors)
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Is Employers' Liability Cover Required? (£10M standard limit of indemnity) | | |
| | Manual Workers | | Non-Manual / Clerical Workers |
No. of Employees/Labour Only Sub-Contractors: (Do not include proprietors, partners or directors) | No. | | No. | |
Annual Wages |
Please provide estimates of annual wageroll split between the categories below: |
| | Manual Workers | | Non-Manual/ Clerical Workers |
Clerical employees: | | | | |
Landscape gardening: | | | | |
Tree surgery at ground level - With chainsaw use | | | | |
Tree surgery at ground level - Without chainsaw use | | | | |
Tree surgery working at height | | | | |
Fencing and planting | | | | |
Forestry felling (Mechanised) | | | | |
Forestry felling (Manual) | | | | |
Powerline work | | | | |
Any other manual work (please describe below if applicable):
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Employers' Reference Number (optional) |
Employers' Reference Number (ERN) (if available): | | (e.g. 123/AB12345 or 'Exempt') |
Turnover |
Please provide estimates of your anticipated turnover, please between the categories below: |
Landscaping/Fencing/Planting: | | | | |
Tree Surgery at Height: | | | | |
Tree Surgery at Ground Level: | | | | |
Power Line Work: | | | | |
Forestry Contracting: | | | | |
Timber Sales: | | | | |
Any Other Work (please describe below if applicable):
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Contractors All Risks / Plant / Equipment / Tools (Optional) |
Is Contractors All Risks / Plant / Equipment cover required? | | Yes No |
Maximum value of any one contract: | | | | |
Own Plant / Tools Equipment (if required) |
Total value of own plant, tools and equipment: | | | | |
Value of Chippers and Chainsaws: | | | | |
Value of Harvesters and Forwarders: | | | | |
Value of All Other Plant: | | | | |
Hired-In Plant (if required) |
Total value of Hired-In Plant: | | | | |
Annual charges/payments made for Hired-In Plant: | | | | |
Employees Tools (if required) |
Total value of Employees Tools: | | | | |
Limit any one Employee: | | | | |
Professional Indemnity (Optional) |
Is Professional Indemnity cover required? (Cover for any advice, design specification or certification you may provide, e.g. reports, etc.) | Yes No |
Limit of indemnity required: | |
Please confirm your fee income from professional activities in the last 12 months: (NB. This is normally less than your turnover) | |
Please confirm the type of professional activities you carry out: (e.g. reports, etc.) | |
Are you aware of any claims or circumstances that could lead to a claim in respect of professional indemnity insurance? | Yes No |
If yes, please provide details: (i.e. date you bacame aware of claim/incident, amount being claimed against you, circumstances of claim/incident, etc.) | |
Commercial Legal Expenses Cover (Optional) |
Is Commercial 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: | | (dd/mm/yyyy) |
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, Faraday, Zurich, etc. |