Liability Insurance Quote Form

Step 1 of 3 - General Details

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Email*
Contact Number*
Mobile Number
Date cover required from?*
Title
Name*
FirstLast
Company name*
Your position in the business
Company Status
First line of address*
Postcode*

Primary Trade*
Secondary Trade (if applicable)
Please explain exactly what you do?
Number of Principals/Partners/Directors:
Number of Employees:
If you are a Principal/Partner or director then you should not include yourself as an employee
How many YEAR(S) experience do you have?
How long have you been established? (In Years)
What PUBLIC LIABILITY Limit do you require?
Do you require tools cover?
Please specify amount for tools cover
Do you work solely on Private Dwelling Houses, Offices, Shops only?
If No, please specify locations*
Do you use any Fix powered woodworking machinery?
Do you make any use of heat?
Do you make any use of heat?(Welding, electric oxy-acetylene, hot air guns, blow lamps/torches, tar bitumen or any other equipment or process involving the application or use of heat)
What percentage of work involves heat use?*
Do you work above 10 metres in height (32 feet)
If Yes, What is the max height you work at? (In metres)
Total annual turnover? (£)
Total annual wageroll? (£)
Have you had any Public or Employers Liability or tools claims in the last five years?
If Yes, How many?
Please provide details of all claims : Dates, Type of Claim and Loss Amount

Any additional information?
We've made some assumptions to help speed up your quote.

Please confirm you meet all of the following criteria:

1. You are not involved in demolition other than as part of a contract to rebuild by you
2. You do not work with silica, asbestos or substances containing asbestos nor do you work with acids, gases, explosives, radioactive or similar dangerous liquids or chemicals
3. You do not work on power stations, nuclear installation or establishments, refineries, bulk storage or premises in oil, gas or chemical industries or offshore structures
4. You do not work on aircraft, hovercraft, aerospace systems, watercraft, railways, underground or underwater
5. No insurer has cancelled, declined to renew or declined to provide cover in respect of you or your partners or directors
6. You or any partner or director have never been convicted for any criminal offence involving dishonesty, arson, theft or wilful damage or for a breach of any stature relating to health and safety at work or has any prosecution pending or outstanding
7. You do not carry out any demolition work other than as part of a building contract

Your insurance is based upon the information provided to the insurance company and you must ensure that all such information is complete and accurate and that any facts that may influence the insurer's decision to accept and pay a valid claim are disclosed. Failure to disclose material information may invalidate your insurance and could mean that all of part of a claim may not be paid.

I have read and understood your terms of business.
I have read and amended the above form where necessary and all answers are correct to the best of my knowledge and belief *
- I Agree

Liability Insurance Quote Form

Step 1 of 3 - General Details

Tradesman and Professional Liability

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High Risk Liability Insurance