*What is Your Business Name?
*Select Business Category —Please choose an option—Public Liability CoverEmployee Liability CoverTradesman Liability CoverProfessional Indemnity CoverCyber Liability CoverProduct Liability CoverDirectors’ & Officers’ Liability CoverLegal Expenses InsuranceCarrier Legal Liability CoverTrade Credit InsuranceSelf Employed Liability CoverOther
If other please explain
*Title —Please choose an option—MrMrsMissMSProfessorDrSir
*First Name
*Last Name
*Main Contact Number
*Business Email Address
What trade/occupation or profession do you require cover for?*
What is your business address?*
*Insurance Cover Start Date
*Select any of the following that apply to any proposer, director or partner of the Trade or Business or its Subsidiary Companies if they have ever, either personally or in any business capacity:
NoneHad any convictions or criminal offences which are not spent under the Rehabilitation of Offenders Act or has any prosecutions pending.Been declared bankrupt or insolvent or been the subject of bankruptcy proceedings or insolvency proceedings.Had a proposal refused or declined.
Had an insurance cancelled.Had a renewal refused.Had special terms imposed.Been the owner or director of, or partner in, any business, company or partnership had a county court judgement awarded against them.Been disqualified from holding company directorship.
Been served with a prohibition or improvement order under health and safety legislation.Been convicted of, charged (but not yet tried) with or officially cautioned for a breach of any Health and Safety or Welfare or Environmental Protection legislation.Been the subject of a recovery action by Customs and Excise or the Inland Revenue the Inland Revenue.
If yes any of above then could you please give more detail
Employees Details YesNo
Employee Type (Full time/Part Type/Care Taker etc.)
Number of Employees (Example: 2-Full Time, 3-Part Time)
PAYE No
Is any work away carried out other than collection and delivery
Does any employee work with heat or fire
Wageroll
Public Liability YesNo
Limit of Indemnity —Please choose an option—£1000000£2000000£5000000£5000000+
Additional Information
Professional Indemnity YesNo
What is your or the Trade or Business name?*
What type of business is it? e.g. Architect*
Where does your business carry out work or have contracts?
Products Liability YesNo
Turnover
Turnover Breakdown
Turnover from UK (etc.)
Wholesalers Finished Goods imported from: NoneAsiaAustralia, NZ, USA and CanadaEU (exc UK)Rest of world (exc UK)
Employers Liability YesNo
Limit of Indemnity—Please choose an option—£1000000£2000000£5000000£5000000+
Legal Expenses YesNo
Limit of Indemnity —Please choose an option—£50000£100000£250000
Claims History Any Claim in last 5 years YesNo
Please send us any documents that may help to get a quote (You can send us any insurance schedules or business documents)
Please provide any information you would like for your business/trade or profession.
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