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 different to the above)
Trading Status:
- - - - - - Please Select - - - - -
Sole Trader
Partnership
Limited Company
Limited Liability Partnership
Unincorporated Association
Business Address:
Postcode:
Do you have a different correspondence address? Yes No
Correspondence Address:
Correspondence Postcode:
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 Details
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. details 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 had any County Court Judgements (CCJ's) / 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 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 Details
Description of your work activities:(Please describe as fully as possible and a percentage split between each activity, where you carry out more than one activity)
Please confirm the type of products fabricated:(e.g. ballustrades, steel staircases, gates, railings, etc.)
Do you work on, or are any of the products intended for installation in or on motor vehicles? Yes No
If yes, please provide details:(e.g. type of products, and type of vehicles worked on, etc.)
If yes, please advise the percentage of work involved in the above activity:
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Are any of the products/components Safety Critical?(e.g. brake discs, steering, track rod ends, 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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Trading Experience
How many years has your business been trading?
Please Select
0 Years
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12 Years
13 Years
14 Years
15 Years
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18 Years
19 Years
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21 Years
22 Years
23 Years
24 Years
25 Years
26 Years
27 Years
28 Years
29 Years
30 Years
30+ Years
Number of years previous experience in this trade:(A minimum of 3 years previous experience is required if you have 0 years trading)
Please Select
0 Years
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
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15 Years
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25 Years
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27 Years
28 Years
29 Years
30 Years
30+ Years
Work Premises
Are you based at home or do you operate from separate dedicated business premises? Home Business Premises
Work Away
Please confirm the percentage of your 'work away' from your base:('base' being your home or own business premises)
- - - - - - - - - - - - - Please Select - - - - - - - - - - - - -
100% work away from base, 0% work at base
90% work away from base, 10% work at base
80% work away from base, 20% work at base
70% work away from base, 30% work at base
60% work away from base, 40% work at base
50% work away from base, 50% work at base
40% work away from base, 60% work at base
30% work away from base, 70% work at base
20% work away from base, 80% work at base
10% work away from base, 90% work at base
0% work away from base, 100% work at base
Please describe any work activities carried out away from your premises (if applicable):(e.g. installation, repair, etc.)
Do your work activities include the erection of steel framed buildings? Yes No
If yes, please advise the percentage of work involved in steel erection:
0%
5%
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Type of Premises Worked at (if working away from own premises) (must add up to 100%)
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.) ? %
Schools, churches or public authority buildings? %
Industrial buildings (e.g. industrial units, factories, etc.) ? %
All other premises / locations (state below if applicable) ? %
Total: 100%
Hazardous Locations (if working away from your own premises)
Is work carried out at any hazardous locations?(These can include, but are not limited to; offshore installations, railways, motorways, bridges, viaducts, power stations, nuclear installations, oil, gas or petrochemical refineries, aircraft/airports/airside, quarries, mines, watercraft/ships, docks, harbours, piers, towers, steeples, hospitals and other medical facilities.) Yes No
If yes, please state the type of locations and the frequency at these locations:
Is any work undertaken outside of the U.K.? Yes No
If yes, please provide details:(i.e. area/country working at, percentage of turnover outside UK)
Professional Services
Do you provide professional services for a fee such as advice/consultancy, design, testing, inspection and certification? Yes No
Heat Work - at your own premises
Please confirm the percentage of time using heat at your business premises?(e.g. using welders, grinders, flame cutting equipment, etc.)
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Heat Work - away from own premises (if applicable)
Is any heat work carried out away from your business premises? Yes No
Please confirm the percentage of time using heat away from your business premises?
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5%
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Please state the type of heat equipment used:(e.g. welder, grinder, flame cutting, etc.)
Work at Height - away from your premises (if applicable)
Please confirm the maximum height you would work away from your business premises:(up to 15 metres standard height limit)
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50+
metres
If you work above 15 metres, please provide details:(i.e. details of work above 15 metres undertaken and the percentage of turnover this represents)
Do you or your employees use slings, cradles, bosuns chairs or abseiling equipment?(cherry pickers and platforms are acceptable) Yes No
If yes, please provide details:(i.e. details of equipment used and the percentage of work this represents)
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 and employers liability insurance)
Employers' Liability (Compulsory by Law if you have employees or use labour only sub-contractors)
Is Employers' Liability Cover Required?(£10M standard limit of indemnity)
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.
Total Annual Wages of Own Employees:
Annual Payments to Labour Only Sub-Contractors (if used):(LOSC's are sub-contractors who supply labour only and work under your supervision)
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 (£'s):(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 (if required) : £500 to £5K maximum
Business Legal Expenses Cover (Optional)
Is Business 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:
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 additional 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.
Renewal Date / Cover Start 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.