public liability insurance

employers liability insurance

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Public Liability Insurance and Employers Liability Insurance
Title:
First Name:
Surname:
Trading / Business Name:
Company Legal Status:
Type Of Trade / Business:
Trade / Business Details:
Specify any trade specific details, e.g. any gas work, 3 phase work, tree felling, any additional trades undertaken etc..
Address 1:
Address 2:
Town / City:
Postcode:
Daytime Contact Number:
Mobile Phone Number:
Email Address:
Max Working Height:
Type Of Heat Used:
(Hold Ctrl to select multiple options)
Max Working Depth:
Limit Of Public Liability:
Is Employers Liability Required:
No
Yes
Number of MANUAL working Directors / Partners / Proprietors / Employees:
Number of Dirctors / Partners / Proprietors / Employees engaged in CLERICAL work ONLY:
Do you employ sub-contractors*:
No
Yes
If YES - Do they have their own Public Liability Cover:
No
Yes
Is Cover for Tools Required:
No
Yes
Have you had any claims in the last 5 years:
No
Yes
Years Experience:
Select the type of premise or location where you work:
Other Areas / Premises you work on (if not shown above):
*Note: Sub-Contractors working for over 50 days a year without their own PL cover should be classed as manual employees and therefore added to the 'Number Of Manual Workers' box.
No
Yes
Have you had any convictions in the last 5 years:
Annual Turnover:
Annual Wages:
How long have you been previously insured: