Lloyd Manley Associates - Contractors Combined Enquiry Form

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Please complete the following Contractors Combined Enquiry form

General:
Company Name:
Address 1:
Address 2:
Post Code:
Telephone:
E-mail:
Business description:
Type of Firm:
	Limited Company
	Partnership
	Sole Trader
When established:
Annual Turnover:	£
Have you had any claims in the last 5 years:	Yes No
If Yes, please give details:
Premises:
Are the above your only business premises?	Yes No
If No, how many premises do you use?
Cover Required
Do you require Contractors All Risks cover?	Yes No
Maximum value any one site:	£
Value of own plant and tools:	£
Value of own site huts & temporary buildings:	£
Do you require cover for employees tools & personal effects?	Yes No
Number of employees:
Cover per employee:
Do you require cover for plant hired in?	Yes No
Annual payments for Plant Hired in:	£
Maximum value of any one item if Plant Hired in:	£
Public Liability limit of indemnity required
Activities:
Clerical, Admin & Sales only:	No of employees Annual wage roll £
Employees working at your premises:	No of employees Annual wage roll £
Employees working away from your premises:	No of employees Annual wage roll £
N.B. if you use labour only subcontractors these must be treated as employees.
Percentage of work below 5m above ground:	%
Percentage of work 5m to 15m above ground:	%
Percentage of work over 15m above ground:	%
Maximum depth of any excavations:	metres
Do you use fixed woodworking machinery?	Yes No
Annual wage roll for such employees	£
Do you use heat equipment away from your own premises?	Yes No
Annual wage roll for such employees	£
Are your products used or do you work in manufacturing premises for the following industries: Petrochemical, Pharmaceutical, Aviation, Marine, Automotive, Oil, Gas or Nuclear?	Yes No
Your name:	Position:

Authorised and Regulated by the Financial Services Authority for General Insurance Business No. 302600