| * Denotes Mandatory Field |
| * Contact Name |
|
| * Telephone Number |
|
| * E-Mail Address |
|
| * Correspondence Address |
|
| |
|
| |
|
| |
|
| * Post Code |
|
| * Date Cover Required |
|
| * Trading Name |
|
| * Number of years trading |
|
| * Main Trade |
|
Secondary Trade
(if applicable) |
|
| Total number of principals - |
|
| * Undertaking manual work |
|
| * Undertaking clerical work only |
|
| Total number of employees - |
|
| * Undertaking manual work |
|
| * Undertaking clerical work only |
|
* Value of Payments to
bonafide sub-contractors |
|
* Annual Turnover
Give estimate if start-up business |
|
* Number of years of experience
carrying out the main trade |
|
* Do you carry out any work
outside of the EU |
|
| If Yes, give details |
|
* Do you carry our any work
in high risk areas |
|
| If Yes, give details |
|
* Do you carry out work
involving the application of heat |
|
| If Yes, give details |
|
* What level of Public Liability
cover is needed |
|
| * Is cover required for tools |
|
* Have you made any claims,
or have any claims been made
against you in the last 5 years |
|
| If Yes, give details |
|
|
