General:
| |
| Company Name: | |
| Address 1: | |
| Address 2: | |
| Post Code: | |
| Telephone: | |
| E-mail: | |
| Business description: | |
Type of Firm:
| |
| | Limited Company |
| | Partnership |
| | Sole Trader |
| | Other |
| If 'Other' please specify: | |
| When established: | |
| Annual Turnover: | £ |
| Have you had any claims in the last 5 years: | Yes
No |
| If Yes, please give details: | |
Premises:
| |
| Are your premises detached? | Yes
No |
| Non combustible construction? | Yes
No |
| Do you have an intruder alarm? | Yes
No |
Sums Insured:
| |
| Buildings: | £ |
Stock of High Risk Items:
(Cigarettes, tobacco, wines,
spirits, precious metals and stones, non-ferrous metals &
portable hand tools) | £ |
| Other Stock: | £ |
| Computers & Electrical Office Equipment: | £ |
| Portable Hand Tools: | £ |
| Other Business Equipment: | £ |
| Number of vehicles operated by you: | |
| Public Liability limit of indemnity required: |
|
Employees:
| |
Clerical, Admin & Sales only
Total Annual wage roll |
£ |
Manual workers at your premises
Total Annual wage roll |
£ |
Manual workers away from your premises
Total Annual wage roll |
£ |
| N.B. if you use labour only subcontractors these must be
treated as employees. |
| 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 |
