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LIABILITY INSURANCE QUOTE

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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:		Help
Work Telephone:		Help
Email:		Help

Work Details

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

Number of Principals/Partners/Directors:
Number of Employees (excluding Principals/Partners/Directors):
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

No work to be undertaken outside Great Britain, Northern Ireland, Channel Islands and the Isle of Man.

No Proposal or renewal has ever been declined, withdrawn or subject to increased terms.

You or any director or partner involved with the Business or any other business have not been declared bankrupt or insolvent.

You or any director or partner involved with the Business or any other business have not been convicted of or charged (but not yet tried) or been given an Official Police Caution in respect of any criminal offence other than a motoring offence.

You or any director or partner involved with the Business or any other business have not been convicted during the past five years of any offence relating to the Health and Safety of your employees or members of the public in connection with your business.

You or any director or partner involved with the Business have not been convicted or have any prosecution pending for any offence involving dishonesty of any kind including for example arson, fraud, theft or handling stolen goods.

You or any director or partner involved with the Business have not had a County Court Judgement served against you or entered into an Individual Voluntary Arrangement in the past five years.

You or any director or partner involved with the Business or any other business have never had a previous insurer decline a proposal, refuse to renew a policy or impose special terms or conditions.

No contracting work will be carried out at or on:
Docks, Harbours or Railways
Watercraft
Offshore gas or oil installations
Chemical or petrochemical works, oil or gas refineries or storage  facilities
Aircraft, airports or airfields
Collieries, mines or quarries
Power stations
Any installation where nuclear processing is undertaken

We may contact you via email shortly before this date next year to offer you a renewal quotation. We may contact you via telephone with regards to this quotation.

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

All Major Cards And Direct Debit Accepted

Copyright © 2024 Ashburnham Insurance Services Limited | Registered Address: 80 London Road, Southend-on-Sea, Essex, SS1 1PG
Registered in England and Wales No. 3106521 | Authorised and regulated by the Financial Conduct Authority under registration number 300777

Claim No.	Loss Date	Policy Section	Details	Amount	Settled
1				£
2				£