Contractors "All Risks"
Full name of Proposer (Please show names of all companies to be insured including all subsidiaries; if not a
limited company, full names of all partners)
Trading Name:
Contact Name:
Company Reg number:
Tel Number:
Address:
Email:
Fax Number:
Postcode
Website Address:
Description of trade or business:
(Please include details of any work
carried out away from the premises)
Risk Address if different
to above:
Date established:
Years Experience:
There is no need for you to complete the rest of this form if your enquiry is of a general nature
and one of our technicians will get back to you.
Alternatively continue and we wll get back to you with a premium indication for you to consider.
Please indicate the sections required and complete the relevant questions:
Do you carry out
demolition only:
Yes (provide details)
No
Details:
Do you carry out work
above 15 metre height:
Yes (provide details)
No
Details:
Do you carry out work
below 1 metre:
Yes (provide details)
No
Details:
What percentage of
work involves:
Welding equipment:
%
Blowlamps:
%
Slings or Cradles:
%
Commercial Property:
%
Fixed wood working
equipment:
%
Please provide numbers, annual wages / salaries / payments for the following:
No:
Wages / Salaries:
Clerical and Non Manual Employees:
Manual Employees:
Wood Working Employees:
Labour only Sub-Contractors:
Do you require cover for the following:
Contract Works and or hired-in equipment:
Yes
No
Max Contract
Value:
Total Value Own
Plant & Tools:
Max value any
one item Hired-In
Plant
Estimated annual
Hire-In charges:
Employers Liabillity:
Yes
No
Clerical Wageroll:
Manual Wageroll:
Public Liabillity:
Yes
No
UK annual
turnover:
UK annual
turnover: (work
away)
USA / Canada
annual turnover:
All other annual
turnover:
3 Year claim history:
Details:
Year
Amount
Please note the above information will be used to obtain an indication of the premium required.
It may be necessary to obtain further details in order to confirm the premium
and any conditions applying to the cover
