Email Address (required)

Renewal Date or New Venture?

What type of business do you run?

Full Name/ Ltd Company name?

Trading Name?

Telephone/Mobile/Work?

DOB

Email Address (required)

Full Correspondence Address and Postcode?

Full Risk Address and Postcode?

How long trading?

Any claims in past 5 years?

What level of Public Liability cover is required?

If you sell products, where are these imported from?
Provide split in % UK/EU/Asia/ROW/USA & Canada

If you manufacture products, please provide full details of what you make, the process used to manufacture, where any products are sourced from and evidence of quality care/testing/ Safety

Number of Employees?

Annual Wage roll?

Any use of bona fide sub-contractors?
e.g. Agency Door staff, if yes provide total annual £

Any use of labour only sub-contractors?
e.g. staff hired on a job by job contract basis, if yes provide total annual £

Annual Turnover?

Does Public Liability cover require extending away from the premises?
Premises/UK/EU/ROW/USA & CANADA?
Provide split in turnover %

Current insurer and current price?

How did you hear about us?

Any CCJ or Liquidations? Or Convictions?
Anything else to declare

Anything further you wish to disclose?

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