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Manufacturers Insurance Quote Form

For UK Customers Only

Please insert your details here and one of our business insurance advisers will contact you shortly.

This form is designed for quotes for single premise manufacturers insurance only. Manufacturers Insurance policies are flexible policies designed to provide cover for manufacturers the sections of cover that you require i.e. contents/plant/machinery, buildings (optional), business interruption, public/product liability, employers' liability, money, goods in transit, legal expenses cover, etc.

If you have more than one premises or require assistance when completing this form, please phone us on 01623 641 386 and we will be happy to help.

Contact/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 operating as a limited company)
Business Trading Name:
(if different to the above)
Trading Status:
Are any subsidiary companies
to be included under this insurance?
Yes     No
If yes, please provide the name(s) and
address(es) of any companies you wish to include:
Business Address:
Business Postcode:
Do you have a different correspondence address?Yes     No
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

Have you or any partner or director ever been convicted of or charged (but not yet tried) with any criminal offence?Yes     No
If yes, please provide full 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.)
Have you, or any partner or director ever been declared bankrupt, insolvent, the subject of a
winding up order or liquidation or the subject
of any county court judgements or sheriff decrees?
Yes     No
Please provide details:
(e.g. date(s) of bankruptcy/insolvency/CCJ/IVA,
amount of bankruptcy/insolvency/CCJ/IVA (£'s),
date discharged, or please confirm if still current,
circumstances of bankruptcy/insolvency/CCJ/IVA, etc.)
Have you, or any other partner or director ever been a director or partner of a company which has gone
into insolvency, liquidation, receivership or administration?
Yes     No
If yes, please provide details:
(e.g. name of previous company,
date(s) of insolvency/liquidation/receivership/administration,
reason for insolvency/liquidation/receivership, etc.)
Have you, or any other partner or director
ever been the subject of a recovery action
by Customs and Excise or the Inland Revenue?
Yes     No
If yes, please provide details:
Has any insurer ever refused renewal, declined/cancelled cover or imposed any special terms?Yes     No
Please provide details:
(e.g. details/reason for any insurance refused/
cancelled/special terms imposed, etc.)
Year Business Established
In what year was the business established? (yyyy)
Year established at your current address? (yyyy)
Number of Years Experience (if a new venture)
Number of years experience (if a new venture): years
Business Details
Full description of manufacturing activities:
(Please describe as fully as possible.
Please including a percentage split if you
carry out more than one activity)
Premises Details
Type of premises:
(e.g. industrial unit, commercial building, retail premises, etc.)
Type of area that the premises are located:
(e.g. commercial, industrial, residential, rural, etc.)
Are you the sole occupant of the premises?Yes     No
If no, please provide details:
(i.e. Number of other businesses/tenants,
type of business and/or stock they keep at premises, etc.)
Are the areas / space used by other businesses
fully self-contained with their own means of access?
Yes     No
Is your portion of the building(s) self-
contained with its own means of access:
Yes     No
If No, please provide details:
Unoccupancy
Are any parts of the
building at present unoccupied?
Yes     No
Please provide details of unoccupancy:
(i.e. percentage unoccupied,
how long unoccupied, etc.)
Are the premises ever left
unoccupied for more than 30 days?
Yes     No
If yes, please provide details:
Are the premises in a good state of repair and maintained?Yes     No
Health & Safety
Have you or any partner or director ever
been prosecuted under the Health & Safety Act?
Yes     No
If yes, please provide details:
Flood / Subsidence Details
Has the premises or any adjacent
premises ever suffered from or shown
any signs of subsidence or ground movement?
Yes     No
Please provide details of the damage:
(i.e. date of damage,
details of repairs carried out,
cost of damage, etc.)
Are there any trees and/or shrubs
which are more than 5 metres high
and within 10 metres of the premises?
Yes     No
If yes, please provide details:
(i.e. type of trees (e.g. oak, etc.),
proximity to premises,
max. height of tree(s), etc.
Have your premises or any other premises
within 100 metres ever been affected by flooding?
Yes     No
Please provide details of the damage:
(i.e. date of flood damage,
cost of flood damage,
details of any flood defence measures taken, etc.)
Are the premises at least 250 metres away from the nearest river, lake, canal or tidal waters and not in an area designated as a high flood risk?Yes     No
If no, please provide details:
(i.e. distance to watercourse,
type of watercourse (e.g. river, canal, sea, etc.),
high flood risk details, etc.)
Business Premises Construction Details
Type of Property:
If not detached, please provide details
of the type(s) of business activities carried
out by any adjoining premises (if applicable):
Construction of Walls (e.g. brick, stone, etc.):
Construction of Roof (e.g. tile, slate, metal, etc.):
Do the premises have any Flat Roofing?Yes     No
If yes, percentage Flat Roofing: %
Type of Flat Roofing (e.g. felt on timber, concrete, etc.):
Does the premises have
walls or roofing containing any composite panels?
Yes     No   help
Please specify the core of the composite panels:
(e.g. mineral rock wool, glass fibre, modified phenolic foam, polyisocyanurate (PIR), polyurethane, expanded polystryrene (EPS))
  help
Are the composite panels LPS 1181 approved?Yes     No
What percentage of the
construction contains composite panels?
%
Does the premises have
walls or roofing containing any combustible linings?
Yes     No
If yes, please specify the type of combustible linings:
(e.g. modified phenolic foam, polyisocyanurate (PIR), polyurethane, expanded polystryrene (EPS), etc.)
What percentage of the
construction contains combustible linings?
%
Please state the number of storeys:
Number of storeys
where the floor is of wooden construction?
Are there any basement floors or below ground level?Yes     No
Approximately what year were the premises built? (yyyy)
Are the premises grade listed?
(i.e. Grade I, II, etc.)
Yes     No
If yes, please provide details:
A.T.M.
Is there an A.T.M. cash machine on the premises?Yes     No
Electrical Systems
Do the premises have a current IEE electrical certificate?Yes     No
Heating Systems
What is the main type of heating for the premises?
(e.g. fixed heaters, radiators, etc. - Enter 'None' if no heating.)
Heating fuel type:
Do you use portable heaters?Yes     No
Please provide details of all portable heaters:
(i.e. No. of heaters, type of heaters,
and whether or not the heaters are guarded.)
Details of any other heating (if applicable):
Security Details
Are all your external doors fitted with a minimum of 5 lever mortise deadlocks that comply with BS3621?Yes     No
Are all opening windows fitted
with key operated window locks?
Yes     No
Are your premises protected by an intruder alarm?Yes     No
Is the alarm NACOSS/NSI approved?Yes     No     Not Sure
Type of alarm signalling:
Does the alarm incorporate confirmable technology?Yes     No   help
Is the alarm under your sole control?Yes     No
If linked to a central station,
please confirm level of police response (if known):
Is the alarm maintained annually?Yes     No
Please provide details of
any other security arrangements:
(e.g. roller shutters, window grilles, recorded c.c.t.v.,
security guarding, premises occupied overnight, etc.)
Fire Safety
Do the premises have a fire alarm?Yes     No
If yes, type of fire alarm signalling:
Do the premises have a sprinkler system installed?Yes     No
If yes, please state the specification (if known):
(e.g. 28th Edition, 29th Edition, etc.)
Do you have any combustible
stock or waste stored in the open?
Yes     No
If yes, please provide details:
(e.g. type of stock and
distance from nearest building (e.g. 5 metres))
Do you ensure that all waste (including refuse) is swept up and bagged daily and removed from the premises and/or surrounding yards at least once per week?Yes     No
Trade Declarations
Does the business have in excess of 50 litres of flammable liquids not stored within a proprietary flammables cabinet or specially constructed store?Yes    No
Please provide details of flammable liquids:
(i.e. confirm type of flammable liquids/gases and
and volume/capacity of the liquids/gases kept)
How are the flammable liquids stored?
Do you undertake any paint spraying at the premises?Yes    No
Do you run any machines or processes unattended when no employees are present within the building?Yes    No
Does the business store more than 200
litres of oil, solvents or chemicals in the
open, or in unbunded external storage tanks?
Yes    No
Please provide details:
(e.g. type of substances
volume of substances kept
how the substance is kept/stored, etc.)
Do you have any hazardous plant?
(e.g. coating machines using flammable liquids, oil quench tanks, carding machines, hydraulic oil cellars, spark erosion machines, stentors, frying lines, etc.)
Yes    No
Please provide details of the type of hazardous plant:
Is the hazardous plant
protected by a fire extinguishing system?
Yes    No
Are any heat processes carried out at the premises?
(e.g. oxy-acetylene or similar welding or flame cutting equipment, angle grinders, blow lamps or blow torches, flame guns, hot air guns or other heat producing equipment)
Yes     No
If yes, please confirm type of heat used:
(e.g. oxy-acetylene welding, angle grinders, blow lamps, hot air guns, etc.)
Storage
Is more than 25% of the floor area used
for storage of raw materials and/or stock?
Yes     No
If yes, please confirm percentage of floor area:
Is any storage more than 6 metres in height?Yes     No
Please provide details of storage above 6 metres:
(i.e. how it's stored (e.g. racking, free-standing, etc.),
and the maximum height it is stored at)
Are plastic and/or wooden materials or articles,
flammable liquids, gases or hazardous
chemicals used, stored or manufactured?
Yes     No
If yes, please provide details:
(i.e. type of flammable item(s),
quantity/volume of item(s),
any safeguarding measures in place, etc.
Claims History
Have you, or any other partner or director (in this or any other trading name) suffered any loss or had any claims made against you in the last 5 years?Yes     No
If yes, please provide details:
(i.e. date of claim,
description of claim,
amount claimed £'s, etc.)

Property Cover

Level of Cover Required?
Is Sprinkler Leakage cover required?Yes     No
Do you wish to add cover for Terrorism?Yes     No
Buildings Cover (if owner occupied and required)
Buildings Sum Insured (if required):
(reinstatement value including outbuildings and an allowance
for demolition costs, removal of debris, architects' fees, etc)
Is subsidence, heave and landslip cover required?Yes     No
Tenants Improvements (if renting and required)
Tenants Improvements Sum Insured (if required):
(i.e. to insure improvements you have made as a tenant to the building's fixtures and fittings such as a new counter, suspended ceilings, partitions, lightning, decorations, etc.)
Contents
Plant/Machinery/Contents Sum Insured:
(excluding computers/electronic equipment)
Computers/Electronic Equipment Sum Insured:
Portable Power Tools (within the premises only):
Stock
Trade Stock within the premises:
(excluding 'High Risk/Target' stock such as audio/visual equipment, cigarettes/cigars/tobacco, computer equipment/tablets, computer games, mobile phones, non-ferrous metals, precious metals, jewellery/watches, photographic equipments/binoculars, wines, fortified wines & spirits & explosives.)
Stock of non-ferrous metals (if applicable):
Do you have any other 'High Risk/Target' stock?
(e.g. audio/visual equipment, cigarettes/cigars/tobacco, computer equipment/tablets, computer games, mobile phones, precious metals, jewellery/watches, photographic equipments/binoculars, wines, fortified wines & spirits & explosives.)
Yes     No
High Risk/Target Stock Sum Insured:
Type of High Risk/Target Stock:
Stock in the Open
Stock kept outside in the open:
Deterioration of Frozen Food
Do you require cover for deterioration of frozen food?Yes     No
Please state the freezer contents sum insured:
(i.e. total for contents of all freezers)
Number of refrigeration units:
Maximum age in years of any of the fridge/freezers? years
Maximum value of contents in any one fridge/freezer?
Business All Risks
Do you require 'All Risks' cover
for property/items in and away from the premises?
(e.g. laptops, mobile phones, digital cameras, tablets, etc.)
Yes     No
All Risks Item 1
Item description:
Sum insured:
Single item limit:
(Max. £5,000 single item limit)
Area of cover:

Do you wish to add another 'All Risk' item?Yes     No
All Risks Item 2
Item description:
Sum insured:
Single item limit:
(Max. £5,000 single item limit)
Area of cover:

Do you wish to add another 'All Risk' item?Yes     No
All Risks Item 3
Item description:
Sum insured:
Single item limit:
(Max. £5,000 single item limit)
Area of cover:

External Glass & Signs Cover (if required)
External Fixed Glass:
External Signs and Blinds:
Money Cover
Is money cover required?Yes     No
Money cover during business hours/in transit:
Money cover out of business hours in a locked safe:

Liability Cover

Public Liability
Is public liability cover required?Yes     No  help
If yes, please choose limit of indemnity:
(if greater than £1M limit of indemnity)
help
Is all machinery properly fenced,
guarded, maintained & in good order?
Yes     No
Do you handle or use
any hazardous substances?
(e.g. radioactive/explosive substances,
toxic chemicals/acids, asbestos, silica, etc.)
:
Yes     No
Does any of your work
produce noise levels over 85dB(A)?
Yes     No
Do you carry out any work away from the premises?
(other than collection or delivery)
Yes     No
Work Away Activities
Please describe the work
activities away from the premises:
Do you work at any hazardous
locations away from your premises?
(e.g. airports, docks, dams, reservoirs, lakes, rivers, mines, quarries, tunelling,
mining, chemical works, gas works, oil refineries, nuclear installations, offshore
installations, or bulk oil, petrol, gas or chemical storage tanks, towers,
steeples, chimney shafts, bridges, viaducts, railway, motorways, etc.)
Yes     No
If yes, please provide details:
type of the locations,
the type of work carried out, and
the percentage of your turnover at theses locations, etc.)
Do any of your activities away
from the premises involve the use of heat?
(e.g. blow lamps, welders, oxy-acetylene, grinders, etc.)
Yes     No
Please confirm the the type of heat used:
(e.g. welding, blow lamp, etc.)
Please confirm the percentage of time using heat (e.g. 10%):%
Maximum Height Worked:
Maximum Depth Worked at:
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 insurance)
  help
 
Product Liability
Is product liability cover required?Yes     No  help
If yes, please choose limit of indemnity:
(This is normally the same as your public liability limit)
help
Please describe the goods
being sold/supplied/manufactured:
Do you have offices, assets,
representations or agents outside the UK?
Yes     No
Will any of your products be supplied
directly or indirectly to the USA/Canada?
Yes     No
If yes, please confirm percentage of turnover:%
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:
(i.e. details of the product(s) and
the percentage of turnover that this represents, etc.)
Are any of the products intended for the
automobile industry and/or motor vehicles?
Yes     No
If yes, please provide details:
(i.e. details of the product(s) and
the percentage of turnover that this represents, etc.)
Do you import any products, materials or components?Yes     No
If yes, please confirm percentage of products imported from:
Europe:%
Asia:%
Australia/NZ/USA/Canada:%
Rest of World:%
Are any 'Hold Harmless' agreements in place?Yes     No
 
Turnover  help
Turnover of your business in the U.K. (£'s):
Turnover of your business in Europe (£'s):
Only complete if applicable
Turnover of your business in USA/Canada (£'s):
Only complete if applicable
Turnover of your business in Rest of the World (£'s):       
Only complete if applicable

Employers' Liability (Compulsory by Law if you have employees or use labour only sub-contractors)
Is Employers' Liability cover required?Yes     No  help
Employers' Liability limit of indemnity:

Wages/No. of staff - At the Premises
     Manual Workers     Non-Manual /
    Clerical Workers
Number of Principals/Partners/Company Directors:
Annual Wages of Principals/Partners/Co. Directors (£'s):
Number of Employees:
(Do not include proprietors, partners and directors)
Annual Wages of Employees (£'s):
Do any of your employees
use fixed woodworking machinery?
Yes     No
Number of fixed woodworking machine operators:
Annual Wages for woodworking machine operators (£'s):
Do you or any of your employees carry out work away from your premises other than collection or delivery?Yes     No

Wages - Work away from the Premises (if applicable)
Annual Wages of Principals/Partners/Co. Directors (£'s):
Annual Wages of Employees (£'s):
Annual Wages of Commercial Travellers/Salesmen (£'s):
Annual Wages of Employees 'working away' using heat (£'s):
(e.g. using blow lamps, welders, hot air guns, grinders, etc.)

Business Interruption

Do you require Business Interruption Cover?
(i.e. loss of profit/revenue following an insured event, e.g. fire, flood, etc.)
Yes     No  help
If yes, please state the
Gross Profit/Gross Revenue of your business (£'s):
If yes, please state the period
of time you wish the cover to extend?
12 months
18 months
24 months
36 months
(allow sufficient time for
rebuilding/refurbishing and further
time to resume normal trading)

Do you require cover for loss of Book Debts?Yes     No
If yes, please indicate the maximum
amount of Gross Fees and Debit
Balances outstanding at any one time (£'s):
 
Goods In Transit Cover
 
Do you require goods in transit cover?Yes     No
Own Goods
Do you required cover for carriage of own goods?Yes     No
Please state the total number
of own vehicles for carriage of own goods:
Please state the maximum
sum insured required per vehicle:
Territorial limit required:UK
EU
USA & Canada
Worldwide
Annual Sendings (UK)
Do you require cover for sendings within the UK?Yes     No
Haulage Contractors (if required)
Estimated annual carryings by haulage contractors?
Max. value any one consignment?
Rail (if required)
Estimated annual carryings by rail?
Max. value any one consignment?
Post (if required)
Estimated annual carryings by post?
Max. value any one consignment?

Fidelity Cover / Theft by Employees
 
Do you require cover for theft by employees?Yes     No
Please confirm the total number of persons employed:
Do you obtain written references
confirming the integrity of employees?
Yes     No
Do you have a system whereby you or
at least two employees check stock, money
and all other business records at least monthly?
Yes     No
Aggregate limit of indemnity required:
Limit of indemnity for any one employee:

Commercial Legal Expenses Cover

Is commercial legal expenses cover required?
(£100,000 limit of indemnity)
Yes     No  Help?
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:

Management Liability Cover

Is directors and officers cover required?
(Cover for any 'wrongful act' of a director or officer of the company)
Yes     No  Help?
Limit of indemnity required?
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, please provide details:
(i.e. reason for not being able to comply with above)

Professional Risks

Do you provide any advice, design or specification?Yes     No  Help?
If yes, do you require professional indemnity cover?Yes     No
If yes, limit of indemnity required?  Help?

Other Covers
 
If there is any additional information that
you wish to disclose, or cover that you
wish to include, please provide details:
(e.g. engineering inspection, etc.)
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

Renewal date / date cover required: (dd/mm/yyyy)
Current renewal premium / best quote (£'s): per annum
(This will help us to get you a better quote.)
Name of current / previous insurer:
(e.g. Aviva, AXA, Allianz, QBE, RSA, Zurich, etc.)

Request Manufacturers Insurance Quotation

Disclosure
Please ensure that all the information you have provided is correct and that you have answered all the questions accurately then press the 'Request Manufacturers Insurance Quotation' button to send your quotation details to us.


Estimated Quote Time: 1 to 72 hours