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Client Details

Proposer / Company Name

Please enter the Proposer's name / Company Name

Trading Name(s)

Contact Name

Please enter a contact name

Email Address

Please enter a valid email address

Confirm Email Address

Please confirm your email address

Phone Number

Please enter a valid phone number

Trading Address

Postcode

Please enter a valid postcode

Property Name / Number

Please enter a valid address

Street

Please enter a valid address

Locality

City / Town

County

Correspondence Address

Is the Correspondence Address different to the Trading Adress?
Yes No

The Business

Are there any additional addresses or trading locations?
Yes No

Where did you hear about Alarminsure?

How many years have you been trading?

What is the renewal of expected start date for this policy?

Please enter the date you would liekt he cover to start

Company Type?

Are you a current member of any industry inspectorate bodies?

Are you a current member of any industry inspectorate bodies (continued)?

Professional Accreditations?

Professional Accreditations (continued)?

Have you or any of your Partners or Directors in connection with any business which you/ they have been involved had any losses whether insured or not, had any claims made against you, or been made aware of any incidents or circumstances that could possibly give rise to a claim?
Yes No

Do you undertake any risk assessments, surveys, design, specification, consultancy, training and/or provide any advice, recommendation or guidance for a separate fee?
Yes No

Do you or any of your employees engage in the application of heat?
Yes No

Heat works?

What is the maximum height worked to?

Do you undertake work at any hazardous locations?
Yes No

Do you or any of your employees handle, transport or work with any of the following: Radioactive substances or devices, explosives, asbestos, silica, toxic or hazardous chemicals, materials giving rise to dust or fumes?
Yes No

Do you or any of your employees handle, transport or work with any of the following: lifts, cranes, hoists, slings, cradles ?
Yes No

Do you or any of your employees use processes involving a noise level in excess of 85db?
Yes No

Do you or any of your employees work on, manufacture or sell products used in aircraft, spacecraft, marine craft, offshore, in nuclear installations, in safety critical parts, motor vehicles or railways?
Yes No

Do you maintain rights of recourse/recovery against all of your suppliers?
Yes No

Are all contracts entered into subject to UK Law?
Yes No

Do all installations comply with the current required European &/or British Standards?
Yes No

Is any of your work undertaken outside the UK?
Yes No

Partners & Directors

You or any of your Partners or Directors either personally or in connection with any business which you/they have been involved with have never :-

been declared bankrupt or are the subject of any current bankruptcy proceeding or any voluntary or mandatory insolvency or winding up procedures?
Yes No

been disqualified from being a Company Director?
Yes No

had a County Court Judgement or Sheriff Court Decree?
Yes No

been convicted of or charged with (but not yet tried) a criminal offence other than a motoring offence or a spent conviction in accordance with the `Rehabilitation of Offenders Act 1974`?
Yes No

been prosecuted or have prosecutions pending under the Health and Safety at Work Act or any other statute or regulation?
Yes No

had any insurance proposal declined, renewal refused, a policy cancelled mid-term by Underwriters, a policy declared void, a claim repudiated, or had any special or increased terms applied?
Yes No

Do you have a formal written Health and Safety policy?
Yes No

Have you carried out the following risk assessments in respect of the Management Of Health And Safety At Work Regulations 1999:? a) manual handling b) COSHH c) working with machinery d) work at height
Yes No

Do you record in document form the above risk assessments?
Yes No

Do you have a formal safety-training plan for employees?
Yes No

Do you have a documented procedure for high-risk activities?
Yes No

Have you maintained and followed all UK Government and HSE advice to prevent and control the spread of infectious diseases to staff, colleagues & customers throughout the 'lockdown' period?
Yes No

Have you undertaken a risk assessment and implemented measures to control the spread of infectious diseases in your workplace in accordance with UK Government and HSE advice?
Yes No

Have these workplace measures been regularly reviewed in line with the relevant guidance and fully communicated to all your employees?
Yes No

Employers' Liability

Do you require Employers' Liability Cover?
Yes No

Number of Staff

Number of Principals / Directors performing clerical work?

Number of Principals / Directors performing manual work?

Clerical Staff?

Manual Staff?

Public and Products Liability

Do you require Public and Products Liability Cover?
Yes No

Limit of Cover

Trade

Percentage of Turnover

Trade (2)

Percentage of Turnover (2)

Trade (3)

Percentage of Turnover (3)

Trade (4)

Percentage of Turnover (4)

Trade (5)

Percentage of Turnover (5)

Trade (6)

Percentage of Turnover (6)

Trade (7)

Percentage of Turnover (7)

Trade (8)

Percentage of Turnover (8)

Annual Turnover

Total Annual Turnover

Annual Payments to Bona Fide Sub Contractors

Key Holding

Do you require Key Holding Cover?
Yes No

Trade Tools

Do you require Tools of Trade Cover?
Yes No

Commercial Legal Expenses

Do you require Commercial legal Expenses?
Yes No

Declaration

Do you wish to disclose any additional information that you feel may be important to an underwriters assessment of this risk?
Yes No

Additional Cover

Do you require cover for your trading premises, building, contents etc.?
Yes No

Do you require cover for contractors all risk, plant, machinery etc.?
Yes No

Do you require cover for Professional Indemnity?
Yes No

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