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  • Extras available contract works, hired in plant, own plant, goods in transit


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    Contact Details
    Title:
    First Name:
    Surname:
    Company/Trading Name (If applicable):


    Correspondence Details
    House number:
    Street:
    Town:
    County:
    Post code:
    Home Telephone:
    Work Telephone:
    Fax:
    Email:


    Work Details
    Trade: Can't find your trade listed?
    Second Trade:
    Third Trade:

    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
    Limited Company: Yes No
    Years Experience:
    Years Trading:

    Public liability limit of indemnity:
    Cover Date:

    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) Yes No

    Insurance/Claims History
    Have you been continuously insured for the past 3 years immediately preceding the cover date selected? Yes No
    Have you had any claims in the last 5 years: Yes No

    Terms and conditions


    Do you agree with the above terms and conditions: Yes No