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Consultants Insurance Quote Form

For UK Customers Only

Please insert your details below and one of our advisors will contact you shortly with a quotation.

This form is designed for quotes for Consultants Public Liability / Employers Liability Insurance with the option to include Professional Indemnity Insurance.

If you have any problems with completing this form, please phone us on 01623 641 386 for assistance.

Personal/Company Details

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 applicable):
Trading Name (if applicable):
Trading Status:
Occupation/Profession:
Business Address:
Postcode:
Daytime Telephone Number:
Mobile 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.
General Information

Have you, or any other partner or director ever been convicted of or charged (but not yet tried) with any criminal offences other than a motoring offence?Yes     No
If yes, please provide details:
(e.g. type/reason for conviction(s),
date(s) of conviction(s),
details of any fines and/or community service (if applicable),
length of custodial sentence(s) (if applicable),etc.)
Has any insurer ever refused renewal, declined or cancelled cover or imposed any special terms?Yes     No
If yes, please provide details:
(e.g. details/reason for any insurance refused/cancelled/special terms imposed, etc.)
Have you, or any other partner or director ever had any county court judgements/sheriff decrees/IVA's or ever 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/CCJ/IVA,
amount of bankruptcy/insolvency/CCJ/IVA (£'s),
date bankruptcy discharged / date 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 or improvement order by the Health & Safety Executive?Yes     No
If yes, please provide details:
(e.g. date of prosecution(s)/prohibition order,
details of offence(s),
details of any fines/action taken (if applicable), etc.)
Business Activities
Description of your work activities:
(Please describe as fully as possible) help
Is work carried out away from your
business premises at any hazardous locations?
Yes     No help
If yes, please state type of location(s) and the
percentage of work spent at the location(s):
Do you work with asbestos, chemicals,
or any other hazardous substances
which could be harmful to health?
Yes     No
If yes, please provide details:
Is any work undertaken outside of the U.K.?Yes     No
If yes, please provide details:
(i.e. area/country of work,
percentage of turnover for work outside UK)
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) year(s)
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, whether insured or not?
Yes     No
If yes, please provide details:

Details Of Cover Required

Public/Product Liability
Public/Product Liability limit of indemnity:  help
  Manual
Principals
 Non-Manual/
Clerical Principals
Number of Proprietors/Partners/Co. Directors:No. helpNo. help
Annual Wages of Proprietors/Partners/Co. Directors:  
Please confirm your annual
payments to Sub Consultants (if used):
(Sub consultants are sub-contractors who work
independently and hold their own insurance)
  help
Employers' Liability (Compulsory by Law if you employ direct employees)
Is Employers' Liability Cover Required?  help
  Manual
Employees
 Non-Manual/
Clerical Employees
No. of Employees: help
(Do not include proprietors, partners or directors)
No. helpNo. help
Total Annual Wages of Employees:  
Employers' Reference Number (optional)
Employers' Reference Number (ERN) (if available):  help
(e.g. 123/AB12345 or 'Exempt')
Turnover
Annual Turnover/Gross Fee Income: 
Professional Indemnity
Is professional indemnity cover required? Yes     No
Limit of indemnity required:  help
Have you or your company previously
held professional indemnity insurance?
 Yes     No
If yes, do you currently have
a retroactive date for your current policy?
 Yes     No  help
If yes, please provide the
retroactive date of your current policy:
 
Are you aware of any circumstances
that could give rise to a professional
indemnity claim being made against you?
 Yes     No
If yes, please provide details: 
Have you been involved in a legal or
contractual dispute, including employee disputes?
 Yes     No
Please confirm the max. value of any one contract: 
Please confirm the largest fee from any one client: 
Do you have any contracts with
USA or Canada domiciled clients?
 Yes     No
Do you undertake any design work? Yes     No
If yes, please provide details: 
Portable Business Equipment
Is cover required for portable business equipment? Yes     No
If yes, please state the sum insured required: 
Territorial limits for portable business equipment: UK only    EU Countries   Worldwide
Have you had any previous claims in the last 5
years in respect of your portable business equipment?
Yes     No
If yes, please provide details of the claim(s):
(i.e. date of claim,
type of claim,
amount paid)
Business Legal Expenses Cover
Is business legal expenses cover required?Yes     No
If yes, please state the limit of indemnity required:
Have you had any previous claims or disputes in
the last 5 years in respect of legal expenses cover?
Yes     No
If yes, please provide details of any claims:
(i.e. date of claim,
type of claim,
amount paid)
Additional Information
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.
Details Of Current / Previous Policies

Cover Start Date / Renewal Date:  (dd/mm/yyyy)
Current Annual Premium / Best Quotation: 
This may help us to get you a better quote
Name of Current / Previous Insurer: 
e.g. Aviva, AXA, Allianz, QBE, RSA, Zurich, etc.

Request Quotation

Disclosure
Please ensure that all the information you have provided is correct, then press the Request Consultants Insurance Quotation button and we will contact you shortly with a quotation.


Estimated Quote Time: 1 to 72 hours