Proposer's Full Name(s):(enter sole trader's name or all partner's names if a partnership)
Contact Name:(if different to proposer's name)
Limited Company Name:(if operating as a limited company)
Trading Name/Trading As (if applicable) :
Trading Status:
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Sole Proprietor
Partnership
Limited Company
Limited Liability Partnership
Unincorporated Association
Business Address:
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.
Have you, or any other partner or director ever been convicted of or charged (but not yet tried) with any criminal offences (other than motoring offences)? Yes No
If yes, please provide details:(e.g. type of conviction(s), date(s) of conviction(s), details of any fines and/or length of custodial sentence(s))
Has any insurer ever refused renewal, declined/cancelled cover or imposed any special terms? Yes No
If yes, please provide details:(e.g. details of any insurance refused/ cancelled/special terms imposed, etc.)
Have you, or any other partner or director ever been declared bankrupt or subject to any County Court Judgements (CCJ's) / IVA's or ever been a director of a company which has become insolvent or gone into administration or liquidation? Yes No
If yes, please provide details:(e.g. date(s) of bankruptcy/insolvency/CCJ/IVA, amount of bankruptcy/insolvency/CCJ/IVA, date bankruptcy discharged or CCJ/IVA settled, circumstances of bankruptcy/insolvency/CCJ/IVA, 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 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 including a percentage split between each activity , where you carry out more than one activity)
Please confirm the type of products you work on:(e.g. ballustrades, steel staircases, gates, railings, pipework, etc.)
Please confirm the percentage split of your work (must add up to 100%):
Metal Fabrication Work Only:(including or excluding welding) %
Welding Work Only (excluding fabrication):(e.g. repair work, etc.) %
All Other Work (state below if applicable) %
Total: 100%
Do your activities include the erection of steel frame buildings? Yes No
If yes, please advise the percentage of work involved in steel erection:
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100%
Do you work in or on any motor vehicles? Yes No
If yes, please provide details:(e.g. type of work undertaken and type(s) of vehicles worked on)
If yes, please advise the percentage of work involved in the above activity:
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100%
Are any of the products/components Safety Critical?(e.g. brake discs, steering, etc.) Yes No
If yes, please provide details:(i.e. description of the product(s), application of the product(s), and percentage of turnover this represents)
Do you work on, or are any of the products intended for installation in or to form part of aircraft, water bourne craft, offshore installations, nuclear installations, petro-chemical works or power stations? Yes No
If yes, please provide details:(e.g. type of products, where product(s) used)
If yes, please advise the percentage of work involved in the above activity:
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5%
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Premises Location
Are you based from home, or do you operate from separate dedicated business premises? Home Business Premises
Please confirm the percentage of your 'work away' from your base:('base' being your home or business premises)
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0% work at base, 100% work away from base
10% work at base, 90% work away from base
20% work at base, 80% work away from base
30% work at base, 70% work away from base
40% work at base, 60% work away from base
50% work at base, 50% work away from base
60% work at base, 40% work away from base
70% work at base, 30% work away from base
80% work at base, 20% work away from base
90% work at base, 10% work away from base
100% work at base, 0% work away from base
Type of Premises Worked at (if working away from own premises)
If you work away from your base, please state the percentage of work at the following locations:
Private dwelling houses and flats? %
Commercial buildings (e.g. shops, offices, etc.) ? %
Industrial buildings (e.g. industrial units, factories, etc.) ? %
All other premises / locations (state below if applicable) ? %
Total: 100%
Is work carried out at any hazardous locations?(e.g. railways / trackside, bridges, tunnels, dams, motorways, viaducts, chemical or petro-chemical work, oil or gas refineries or storage facilities, power stations, nuclear power stations, nuclear installations, airports / airside, quarries, mines, watercraft / ships, docks / harbours, piers, towers, steeples, offshore installations, etc.) Yes No
If yes, please state the type of work carried out, the type of location(s) worked at and the percentage of turnover this work represents:
Is any work undertaken outside of the U.K.? Yes No
Details of area/country of work outside of UK and percentage of time outside UK:
Professional Risks
Do you provide professional services for a fee such as advice/consultancy, design, testing, inspection and certification? Yes No
Heat Work
In addition to using welding equipment, do you use any other sources of heat whilst working?(e.g. angle grinders, blow lamps, blow torches, heat guns, etc.) Yes No
Please state the type(s) of other heat used:(e.g. angle grinders, blow lamp, heat guns, etc.)
Please state the percentage of your time using heat at your own business premises? %
Please state the percentage of your time using heat away from your premises on site (e.g. 20%) ? %
Work at Height - away from your premises (if applicable)
Please confirm the maximum height you would work:
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50+
metres
If any work is above 12 metres, please provide details:(e.g. type(s) of work undertaken, and percentage of turnover that this work represents)
Do you or your employees use slings, cradles, abseiling equipment or tower cranes?(cherry pickers and platforms are acceptable) Yes No
If yes, please provide details:(e.g. type(s) of equipment used, and percentage of turnover that this work represents)
Hazardous Materials
Do you work with asbestos, silica or any other materials hazardous to health? Yes No
If yes, please provide details:(i.e. type of hazardous materials and percentage of your turnover for this type of work)
Trading Experience
How many years has your business been trading?
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year(s)
Number of years previous experience in this trade:(A minimum of 3 years previous experience is required if you have 0 years trading)
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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:
Public/Product Liability
Public/Product Liability limit of indemnity:
£1 Million
£2 Million
£5 Million
£10 Million
Not Required
Manual Principals Non-Manual/ Clerical Principals
Number of Proprietors/Partners/Co. Directors: No. No.
Annual Wages of Proprietors/Partners/Co. Directors:
Please state your annual payments to Bona-Fide Sub-Contractors (if used):(BFSC's are sub-contractors who supply their own materials on site and hold their own public liability insurance)
Employers' Liability (Compulsory by Law if you have employees or use labour only sub-contractors)
Is Employers' Liability Cover Required?
Please Select
Yes
No
Manual Workers Non-Manual/ Clerical Workers
No. of Employees / Labour Only Sub-Contractors:(Do not include proprietors, partners or directors) No. No.
Annual Wages of Employees / L.O.S.C.'s:(LOSC's are Labour Only Sub Contractors)
Employers' Reference Number (optional)
Employers' Reference Number (ERN) (if available) : (e.g. 123/AB12345 or 'Exempt')
Annual Turnover
Estimated annual turnover for the next 12 months:(Please be as accurate as possible, as an over estimation will increase the premium to be quoted)
Tools Cover (optional)
Is Tools cover required? Yes No
Tools Sum Insured: £500 to £5K maximum
Commercial Legal Expenses Cover (optional)
Is Commercial Legal Expenses cover required? 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:
Directors & Officers Cover (optional)
Is Directors and Officers cover required?(Cover for any 'wrongful act' of a director of a limited company) Yes No
Please confirm the limit of indemnity required:
£100,000
£250,000
£500,000
£1,000,000
£2,000,000
£5,000,000
Can you confirm that the company is domiciled in the UK; is privately held; has not raised any funds from external parties; has been in operation for more than 12 months; has its financial statements prepared by a qualified accountant, shows a profit and are not subject to any concerns by the auditors; derives at least 50% of all its turnover from clients within the UK and EU; has not acquired any companies which have increased its total assets by 50% or more; and has no mergers or acquisitions planned and has not had any claims made against it or its directors and is not aware of any circumstances that could give rise to such claim? Yes No
If no, details:
Additional Information
Details of any additional information that 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.
Liability Renewal Date / Cover Start Date: (dd/mm/yyyy)
Current Annual Premium / Best Quote to Beat: This may help us to get you a better quote
Name of Current / Previous Insurer: e.g. Aviva, AXA, Allianz, RSA, Zurich, etc.