Tel: 01623 641 386     
Midlands Insurance Services
 
Midlands Insurance Services Logo


Main Menu



Landowner's Public Liability Insurance Quote Form

For UK Customers Only

Please insert your details below and one of our commercial advisers will contact you shortly with a landowner's liability insurance quotation. Minimum premiums start from £150.00 per annum. Please note that regrettably we are unable to cover land in Northern Ireland.

This form is designed for quotes for Landowner's Public Liability Insurance and protects land owners and/or their business against legal liability for losses from accident or injury that has occurred on their land.

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 owner's name or all partners names if a partnership)
Contact Name:
(if different to proposer's name)
Limited Company Name:
(if operating as a limited company)
Ownership Status:
Correspondence Address:
Correspondence 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.
General Information

Number of Principals/Partners/Directors
Number of principals/partners/directors/committee
members who own, or are responsible for the land:
General Questions
Have you, or any other partner, director or committee member 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 of conviction(s),
date(s) of conviction(s),
details of any fines and/or length of custodial sentence(s))
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/CCJ/IVA,
amount of bankruptcy/insolvency/CCJ/IVA,
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.

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 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 by HM
Customs and Excise or the Inland Revenue?
Yes     No
If yes, please provide details:
Number of Years Land Owned
How many years have you owned the land? year(s)
Details of Land
Are you operating as a residents association?Yes     No
Description of land to be insured: help
(i.e. building land, agricultural field, undeveloped pasture,
woodland, private road, development land, etc.)
Address of land to be insured: help
Postcode (if available):
Please confirm the approximate size of the land:
(e.g. 5 acres, etc.)
Land Activities
Is the land being used as farm land?Yes     No
If yes, is the land being used
for growing crops for commercial benefit?
Yes     No
Do you allow anyone to use
the land to let their animals graze?
Yes     No
If yes, who (e.g. neighbours, other farmers, etc.)?
Is the land used for any equine activities
or any horses or ponies kept on the land?
Yes     No
If yes, please provide details:
Does the land include a private road?Yes     No
Does the land include a communal area
within a residential housing development?
Yes     No
Does the land include any children's play equipment?Yes     No
Does the land include any
parking areas for motor vehicles?
Yes     No
If yes, please confirm the
number of parking spaces available:
Is the parking reserved for residents of the
housing development (and their guests) only?
Yes     No
Buildings / Structures on the Land
Are there any buildings/structures situated on the land?Yes     No
Details of type of buildings/structures on the land:
Are any of the buildings/structures unoccupied?Yes     No
Are the unoccupied buildings structurally sound
and in a secure area, not accessible to the public?
Yes     No
Details of the unoccupied buildings:
Is the liability required to extend to these buildings?
(N.B. Property owners liability only, not buildings cover)
Yes     No
What is the estimated value of the buildings?
Hazardous Use on the Land
Is or was the land to be insured used or ever used, by any Petrol Station, Chemical Works, Gas Works, Oil Refineries, Power Stations, Landfill, Waste Tip, Quarries or Pits, Underground Mines or Mining Operations or any other industries of this nature (i.e. Brownfield site):Yes     No
If yes, please provide details:
(i.e. type of facility (quarry, mine, etc.)
and when it was last worked)
Building / Development Work
Is any current building or re-
development work being undertaken at the location?
Yes     No
If yes, please provide details:
Items Stored on Land
Are there any items stored whatsoever at the location?Yes     No
If yes, please provide details:
Adjacent Land / Buildings
Please provide details of the adjacent land:
(e.g. fields, woodland, housing estate, etc.)
Public Footpaths / 'Rights of Way'
Are there any public footpaths, or
'rights of way' running through the land?
Yes     No
If yes, please provide details:
(e.g. length of footpath and
estimated number of persons using it per week)
Hazardous Features
Are there any watercourses or significant
water features within the land to be insured?
(e.g. streams, rivers, lakes, ponds, etc.)
Yes     No
If yes, details of type of watercourse:
(e.g. river, pond, etc.), size and depth
and if any lifesaving equipment is provided)
Is the land used for any boating,
fishing or the mooring of boats?
Yes     No
If yes, please provide details:
Details of any other hazardous features on the land: help
(e.g. cliffs, ditches, old mine workings/mine
shafts, derelict buildings, quarries or pits, etc.).
If there are no other hazardous features, please enter 'None'.
Security Features
Is security in place to prevent
illegal access to access to the location?
Yes     No
Details of any security features on the land: help
(i.e. boundary walls, fences, gates, etc.)
Income / Turnover
Details of any income/turnover received
from ownership of the land (if applicable):
Claims Experience
Have you, or any other partner or director
suffered any loss or had any claims made
against you in respect of the land in the last 5 years?
Yes     No
If yes, please provide details:

Details Of Core Cover

Public Liability
Public Liability limit of indemnity: help

Additional Optional Covers

Legal Expenses Cover (Optional)
Is Commercial Legal Expenses cover required?Yes     No Help?
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:
Environmental Liability Cover (Optional)
Is Environmental Liability cover required?Yes     No Help?
If yes, limit of indemnity required:
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 Quote:
This may help us to get you a better quote
Name of Current / Previous Insurer:
e.g. Aviva, Commercial Express, Q Underwriting, etc.
Request Quotation
Disclosure
Please ensure that all the information you have provided is correct, then press the Request Landowners Liability Quotation button and we will contact you shortly with a quotation.


Estimated Quote Time: 1 to 3 working days