Business Combined Insurance Enquiry

Please complete this form so that we can obtain a quotation.

* = Required

Your Details

Please provide your name *

Please provide your trading name *

Please provide your trading address *

How long have you been trading from these premises? *

Please provide your telephone number *

Please provide your contact email address *

What is your occupation? *

* If 'other' selected please specify your occupation

What date was the company established? *

What is your annual estimated turnover? *

When would you like your policy to start? *

Number of Workers

Directors - Surveying/onsite		Wage roll
Directors - Clerical		Estimated Wage roll
Employees/Labour-only - Surveying/onsite		Estimated Wage roll/payments
Employees/Labour-only - Clerical		Estimated Wage roll/payments

Equipment

	Total Sum Insured	Max Value any one item
Computer Equipment (which does not leave the office – i.e., desktop computers)		n/a
General Office Contents (furniture, printers etc.)		n/a
Laptops
Portable Surveying Equipment – Owned/Hired
Mobile Phones
Other Equipment

Other Equipment

Cover Requirements

Public Liability Insurance Limit Required: *

£2,000,000

£5,000,000

£10,000,000

No cover required

Employers Liability Insurance (£10m) Required? *

Yes

Professional Indemnity Insurance Required? *

Yes

Assumptions

Our quotations are based on the following assumptions. Just give us a call on 01837 650030 if you cannot agree to all of them.

Neither you or any of your partners or directors in the business:

Have been convicted or charged (but not yet tried) of any criminal offence other than a motoring offence.
Have been declared bankrupt or insolvent or are subject to any current bankruptcy or insolvency or winding up proceedings or any voluntary or mandatory insolvency or winding up proceedings.
Have any outstanding County Court Judgment(s) or Sheriff Court Decree(s).
Have ever been disqualified from holding company Directorship (unless a Sole Trader).
Have been served with a prohibition or improvement order under health and safety legislation.
Have been convicted of, charged (but not tried) with or officially cautioned for a breach of any Health & Safety or Welfare or Environmental Protection legislation.
Have been the subject of a recovery action by Customs and Excise or the Inland Revenue.
Have had any insurance proposal refused or declined.
Have had any insurance cancelled or renewal refused.
Have had any increased premium or special terms applied to any business insurance.
Have any current or ongoing or potential matters that could give rise to any legal or contractual disputes.
Have had any losses or incidents that have or could have given rise to claims within the last 6 years.

The Premises:

Are built of brick, stone or concrete and roofed with slates, tiles, concrete, asphalt or metal with no flat roof.
The building not listed.
Is heated by hot water radiators or Underfloor heating and fuelled by Gas or Electric.
Have fewer than 4 storeys.
Are not in an area with a history of flooding.
Are self-contained with their own lockable entrance door (unless a home office).
Are not shared with other occupants.

And

You do not work at Hazardous Locations such as Aircraft operational areas, chemical works, oil, gas or petrochemical works including offshore, refineries and bulk storage locations, nuclear installations, offshore installations, power stations, railways, watercraft, docks, harbours or boats.

Any other comments?

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