LIABILITY (MAXIMUM 6 PERSONS) QUOTE

1. Name of Proposer and Trading Title:
2. Address of the premises:
Post Code:	Tel. Number:
e-mail (if you have any):
3. Description of Business: (Occupation & Nature of all Business engaged in)
3.1. Percentage of work away from premises	%
3.2. Maximum height level worked
3.2. Do you engage in heat work?	Yes No
if Yes percentage of work away:	%
4. Numbers of years trading:
5. Is the Company a Limited Company	Yes No
6. How many Principals / Partners / Directors work manually?
7. What is the maximum number of employees (Manual)?
8. Do you required Employer's Liability cover for Temporary Workers (Manual) (max. 50 days per year)	Yes No
9. Are there any clerical only staff	Yes No

10. INSURANCE HISTORY
10.1 Have you got previous insurers:	Yes No
10.2 Have you ever been declined, cancelled, refused or special terms:	Yes No
If "Yes" please give full details
10.3 Have you had any claims:	Yes No
If "Yes" please state here:

Do you require Public Liability?	Yes No , if Yes
Do you require Products Liability?	Yes No , if Yes
Do you require Employers Liability?	Yes No
Do you require tools cover?	Yes No , if Yes
Do you use Sub-Contractors?	Yes No
If Yes (percentage of your turnover):	%


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