TRADESMAN'S QUOTE FORM

T: 01704 500999

Please fill in the form below, if you have any questions or are unsure as to how to proceed, please call us T:01704 500999 and we will be more than happy to help.

Your Email:
Proposer Name:
Trading Name:
Address:
Postcode:
Telephone Number:
Date business was established:
Full Business Description:
Can you comply with the following Material Facts statement?
Not been declared bankrupt/insolvent:	Yes No
Not been the subject of bankruptcy proceedings:	Yes No
Not had a proposal refused or declined:	Yes No
Not had a renewal refused:	Yes No
Not had insurance cancelled:	Yes No
Not had special terms imposed:	Yes No
Has no non-motoring convictions or criminal offences:	Yes No
Has no non-motor prosecutions pending:	Yes No
Number of manual employees:
Number of clerical employees:
What Limit of Indemnity do you require for Public Liability:	£1m £2m £5m
Do you require Employers Liability:	Yes No
Do you want to include cover for tools:	Yes No
Please state amount:
Do you want to include Own Plant:	Yes No
Please state amount:
Do you want to include Hired in Plant:	Yes No
Please state amount:
Do you want to include Contract Works:	Yes No
Please state amount:
What is the maximum height you work at:
What is the maximum depth you work at:
Do you use any form of heat?	Yes No
If yes, please provide details:
Previous Claims
Renewal Date
Current Insurer
Target Premium