Corporate Clients

Please complete all of the following fields.
**Denotes compulsory field

Name Of Insured **

Contact Name **

Contact Number **

Email **

Preferred contact method

Please select Phone Email

Are you a new or existing client?

Please select New Existing

If new, please advise how you got our name

Please select Websearch Recommendation Advertising Other

If existing, please enter your Client Reference if known

Do you currently have Contractors insurance for this business?

Please select Yes No

If yes, what is the renewal date?

D: M: Y:

What is the current annual premium that you pay?

Trade

When was the business established (year)?

Number of Proprietors and Partners

Approximate Annual Wage roll of Proprietors and Partners

Number of Employees

Approximate Annual Wage roll of Employees

Number of Labour Only Subcontractors

Approximate Annual Wage roll or Subcontractors

Number of Bona Fide Subcontractors

Approximate Annual Wage roll of Bona Fide Subcontractors

Current Annual Turnover

Public Liability

Please select £1m £2m £3m £5m £10m

Is £10m Employers' Liability cover enough?

Please select Yes No

Contract Works Cover - Maximum value of any one contract

What is the maximum value of a single item of plant that you hire in?

What is the maximum total value of Plant that you hire at any one time?

Own Plant Total Sum insured

Tools cover required?

Please select Yes No

Have you had any claims under this type of policy in the past 3 years?

Please select Yes No

If yes, please specify the number

Please select 1 2 3 4 5 6 7 8 9 10

Have any of these claims been settled for more than £2,500 (approx)?

Please select Yes No

Please provide any further details relating to your application (e.g. working above height of 15m or below depth of 3m / working outside UK ever had request for insurance declined?)