Tree Surgeons Liability Insurance Quotes

Personal/Company Details

Proposer's Full Name(s):
(enter sole trader's name or all partner's names if a partnership)

Limited Company Name:
(if operating as a limited company)

Trading Name/Trading As:
(if different to the above)

Trading Status:

Occupation/Trade:

Business Address:

Business 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

General Questions

Have you, or any other partner or director
ever been convicted of any criminal offences?

Yes No

If yes, please provide details:
(e.g. type of conviction(s),
date(s) of conviction(s),
details of any fines, custodial sentence)

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,
amount of bankruptcy/insolvency,
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.

Have you, or any other partner or
director ever had any insurance refused,
cancelled or any special terms imposed?

Yes No

If yes, please provide details:
(e.g. date(s) of insurance refused/cancelled,
reason for refusal/cancellation,
details of any 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 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)

How is the height work accessed (if applicable)?
(e.g. cherry pickers, etc.)

Do your activities involve the use of rope access?

Yes No

If yes, please confirm percentage of rope access work:
(e.g. 10%)

Trade Specific Questions

Do your activities involve the burning of debris?

Yes No

If yes, please provide details:
(i.e. percentage of turnover involving burning of debris
and any fire precautions taken)

Do your activities include powerline clearance work?

Yes No

If yes, please provide details:
(i.e. percentage of turnover involving powerlines
and any precautions undertaken)

Hazardous Locations

Is any work undertaken in Railway 'Red Zones'?

Yes No

If yes, please provide details:
(i.e. percentage of turnover involving work in 'Red Zones'
and any precautions taken)

Is any work undertaken in Railway 'Green Zones'?

Yes No

If yes, please provide details:
(i.e. percentage of turnover involving work in 'Green Zones'
and any precautions taken)

Is work carried out at any other hazardous locations?
(e.g. towers, steeples, chimney shafts, blast furnaces, dams, canals, viaducts, bridges, tunnels, aircraft, airports, ships, docks, piers, wharves, sea walls, mines, nuclear or chimcial works, gas works, oil refineries, power stations, bulk oil, petrol, gas or chemical storage tanks, motorways, reservoirs, wells, demolition sites, etc.)

Yes No

If yes, please provide details:
(i.e. please state the location of work,
the type of work,
and the percentage of turnover this work represents)

Work Outside of UK

Is any work undertaken outside of the U.K.?

Yes No

If yes, please provide details:
(i.e. area/country of work,
percentage of work outside UK)

Heat Use

Do your activities involve the use of heat?
(other than the burning of debris mentioned above)

Yes No

If yes, please state the type of heat used
(e.g. blowlamp) and percentage use of heat (e.g. 10%):

Work at Height / Depth

Please confirm the maximum height you would work:

metres

Please confirm the maximum depth you would dig:

metres

Professional Services

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)
(A minimum of 3 years previous experience is required if you have 0 years trading)

year(s)

Health & Safety

Do you have a Health & Safety Policy?

Yes No

Do you keep a record of all training and assessments?

Yes No

Do you carry out risk
assessments for each site you work at?

Yes No

Do you supply all employees and sub-
contractors with Personal Protection Equipment?

Yes No

Do you comply with PUWER legislation?

Yes No

Is all your machinery properly guarded
and complies with the latest legislation?

Yes No

Qualifications

Do you have any qualifications in relation to this work?
(Please provide details of your qualifications,
or details of your previous experience if no qualifications)

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:

Tree Surgeons Public / Employers Liability Insurance Quote Form

For UK Customers Only