Enter the names of all Proprietors,
Partners, Directors:
Enter the name of the Company, if
applicable:
Trading
Name:
Address:
:
Town:
County:
Postcode:
Telephone:
Mobile
Telephone:
Your e-mail
address:
Business Status:
Please Select
Private Limited Company
Partnership
Sole Proprietor
Public Limited
Limited Partnership
Your Primary
Trade or Business
Please Select
Other (not listed
below)
Accountants
Actuarial Consultants
Advertising Agency
Aerial
Erectors
Alarm
Installers
Architects
Artexers
Auctioneers
Auditors
Barristers
Bathroom Installers
Book
keepers
Bricklayers
Builders - Alterations & Extensions to
Houses up to 2 floors
Builders - New house building up to 2
floors
Building Construction (1) - Property
Maintenance
Building Construction (2) - Property
Maintenance and New Build
Business Consultants/Advisors
Car
Valeters
Caretakers
Carpenters/Joiners
Carpet
Fitters
Carpet/Upholstery Cleaners
Caterers
Ceiling, Wall and Floor Tilers
Chartered Surveyors
Chimney
Sweeps
Chiropodists
Clerical Services
Composer
Conservatory/Porch Erectors
Curtain/Blind Fitters
Desktop Publishers
DO NOT USE - Builders
Domestic Appliance Engineers
Domestic Kitchen Installers
Domestic Shed and Car Port Erectors
Double
Glaziers
Drain
Cleaners
Draughtsmen
Dry
Stone Walling
Editorial Consultancy
Electrical Contractors
Engravers
Estate
Agents
Exhibition Stand Erectors
Fencing Contractors
Financial Consultants
Flooring Contractors
Flower Arrangers
French Polishers
Furniture Installers
Furniture Repairers
Glaziers
Graphic Designers
Hairdressers (including treatment)
Health and Safety Advisors
Interior Designers
Landscape Gardeners
Locksmiths
Marketing Consultants
Office Equipment Repairers
Painters and Decorators (not industrial)
Piano
Tuners
Plasterers
Plumbing and Heating Engineers (not
industrial)
Quantity Surveyors
Research Consultants
Satellite Dish Installers
Secretarial Services
Shop and Office Cleaners
Shop
Fitters
Sign
Writers
Stonemasons
Suspended Ceiling and Partitioning
Erectors
Tax
Consultant
Telemarketing Consultants
Training Consultants
Wall Tilers - Internal work only
Window
Cleaners
Tree Doctor
Tree Surgeon
Your Secondary
Trade or Business
Please Select
Other (not listed
below)
Accountants
Actuarial Consultants
Advertising Agency
Aerial
Erectors
Alarm
Installers
Architects
Artexers
Auctioneers
Auditors
Barristers
Bathroom Installers
Book
keepers
Bricklayers
Builders - Alterations & Extensions to
Houses up to 2 floors
Builders - New house building up to 2
floors
Building Construction (1) - Property
Maintenance
Building Construction (2) - Property
Maintenance and New Build
Business Consultants/Advisors
Car
Valeters
Caretakers
Carpenters/Joiners
Carpet
Fitters
Carpet/Upholstery Cleaners
Caterers
Ceiling, Wall and Floor Tilers
Chartered Surveyors
Chimney
Sweeps
Chiropodists
Clerical Services
Composer
Conservatory/Porch Erectors
Curtain/Blind Fitters
Desktop Publishers
DO NOT USE - Builders
Domestic Appliance Engineers
Domestic Kitchen Installers
Domestic Shed and Car Port Erectors
Double
Glaziers
Drain
Cleaners
Draughtsmen
Dry
Stone Walling
Editorial Consultancy
Electrical Contractors
Engravers
Estate
Agents
Exhibition Stand Erectors
Fencing Contractors
Financial Consultants
Flooring Contractors
Flower Arrangers
French Polishers
Furniture Installers
Furniture Repairers
Glaziers
Graphic Designers
Hairdressers (including treatment)
Health and Safety Advisors
Interior Designers
Landscape Gardeners
Locksmiths
Marketing Consultants
Office Equipment Repairers
Painters and Decorators (not industrial)
Piano
Tuners
Plasterers
Plumbing and Heating Engineers (not
industrial)
Quantity Surveyors
Research Consultants
Satellite Dish Installers
Secretarial Services
Shop and Office Cleaners
Shop
Fitters
Sign
Writers
Stonemasons
Suspended Ceiling and Partitioning
Erectors
Tax
Consultant
Telemarketing Consultants
Training Consultants
Wall Tilers - Internal work only
Window
Cleaners
Tree Doctor
Tree Surgeon
If heat equipment
is used in any of the following Trades, please
select the type used:
None
Blow Torches
Blow Lamps
Flame Cutting Equipment
Hot Air Guns
Welding Equipment
Equipment type 1
If heat equipment
is used in any of the following Trades, please
select the type used:
None
Blow Torches
Blow Lamps
Flame Cutting Equipment
Hot Air Guns
Welding Equipment
Equipment type 2
Does your work
involve the use of asbestos, chemicals or other
substances which could be harmful to health? :
Please Select
Yes
No
Answer as 'NO' if the only use of chemicals &
substances are those which are normal for that
particular trade.
Do you dispose of
fumes, effluent or other harmful waste? :
Please Select
Yes
No
Please select the
description of where the majority of the trade
or business work is done :
Please Select
Republic of Ireland
Outside of UK
Worldwide
Great Britain
Northern Ireland
Has the proposer,
director or partner ever had a proposal refused
or declined, or had an insurance cancelled,
renewal refused or had special terms imposed? :
Please Select
Yes
No
Does the
proposer, partners or directors of the proposer
have any convictions for any criminal offence
involving dishonesty arson theft or wilful
damage or any prosecutions pending? :
Please Select
Yes
No
For any of the
classes of insurance proposed, has the
proprietor any partner or director suffered any
loss or had any claim made against them whether
insured or not in the last 5 years? :
Please Select
Yes
No
Has any of the
proprietors, partners or directors been declared
bankrupt or insolvent or been the subject of
bankruptcy proceedings? :
Please Select
Yes
No
Please enter the
number of working proprietors and partners :
Please Select
1
2
3
4
5
Is cover for
Employers Liability required?
Please Select
Yes
No
The
temporary employees extension will only apply if
'YES' is entered to this question and at least
one manual employee, for contracting trades or
one clerical employee, for professional trades
is entered.
Excluding
Partners & Proprietors, please enter the number
of working directors & employees at anyone time
engaged solely in clerical work:
Please Select
1
2
3
4
5
Excluding
Partners & Proprietors, please enter the number
of working directors & employees at anyone time
engaged solely in manual work:
Please Select
1
2
3
4
5
Is cover required
for loss of or damage to portable tools and
business equipment and property in transit? :
Please Select
Yes
No
Do employees or
labour only sub contractors use fixed
woodworking machinery? :
Please Select
Yes
No
Public liability limit (£1m,£2m,£5m) :
Please Select
£1,000.000 Cover Required
£2,000.000 Cover Required
£5,000.000 Cover Required
(Please ensure that all fields/questions are
completed).