Telephone +44 (0) 1892 549 822
Enquiry Form for Public and Employers Liability
Please fill in the form below.
* Required fields
CLIENT DETAILS
* Name of proposer or company
* Risk Address
* Postcode
* Contact Name
Different Contact Address
* Contact Address
* Contact Postcode
* Telephone
Fax
* Email Address
BUSINESS DETAILS
* Full description of your business
* Date established (YYYY-MM)
* Percentage of the work carried out away from the premises (%)
* Is any hotwork undertaken?
* Use of hotwork (%)
* Give details of any hotwork undertaken
* Maximum height worked (metres)
LIABILITY
* Number of clerical workers
* Number of manual workers including manual principals
Employers Liability: £10,000,000
* Estimated Wageroll: Clerical (£)
* Estimated Wageroll: Direct manual (£)
* Estimated Wageroll: Bona fide subcontractors (£)
* Estimated Wageroll: Labour only subcontractors (£)
* Public/products liability limit (£)
* Estimated Turnover (£)
CLAIMS
* Have you made any claims within the past 5 years?
* Details
* Has a policy ever been cancelled or have special terms been imposed?
* Details
* Renewal Date (YYYY-MM)
If you have any further insurance requirements or material facts which should be disclosed to underwriters please give details