Quotation Request Combined Liability - B2C About You Public Liability Employers Liability Key Facts Statement of Fact Cover Details About YouWhat is your Company and/or Trading NameThis is the name that will appear on all documentation including the schedule and employers liability certficate What is the Contact Name of the person completing this application -- Mr Mrs Miss Ms Dr Prof. Capt. Lord Lady Major Rev. Master Exec(s) of Mx What is your Principal AddressMain correspondence address UDPRN UPRN Organisation Line 1 Line 2 Town/City County Postcode Enter address manually or Enter address manually Use address lookup What date would you like the policy to start 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2025 What is your current business statusPlease select from the available list - Select - Limited Company Sole Trader Partnership Limited Partnership What year did you start trading? (YYYY)Please advise what year you started trading Select your Main ProfessionPlease select from the available listIf you can't find your's in the list please choose 'Other' - Select - Accountants or Bookkeepers Acoustic Engineers Actuarial Consultancy Actuary Administration Advertising Agency Advertising Consultancy Advertising Contractors Aerial Erectors (Domestic Work Only) Aerobics Fitness Instructor (ex Sports Training) Agricultural Consultants Agricultural Contractors Agricultural Equipment Engineeres Air Conditioning & Refrigeration Engineers Air Conditioning Engineers Alarm Installers (Domestic & Commercial Work Only) Arbitrator Architects Artexers Artists Auctioneer Auditing Author Bakers Barrister Bathroom Installer Beauticians Bedroom Furniture Installation Boiler Services (Domestic) Boiler Services (Non-Domestic) Bookmakers - On Course Bricklayers (10m Height Limit) Bricklayers (No Height Limit) Builders (10m Height Limit) Builders (15m Height Limit) Butlers Cake Makers/Decorator Canvassers Car Audio/ Alarm Installers Car Valeters Car Window Etching Carpenters and Joiners (inc work away, ex wwm) Carpenters and Joiners (premises only inc. wwm) Carpet & Upholstery Cleaners Carpet Fitters Cartoonist Caterers Cavity Wall Insulation CCTV Installation Ceiling Contractors Chartered Surveyors Chauffeur Chef Chimney Sweeps Chiropodists Claims Assessing Cleaners (Domestic & Commercial Onlyl) Cleaners (Industrial) Clerical Services Commissioners For Oaths Composer Computer Consultants Computer Engineers Conservatory & Porch Erectors Consultant Engineers Conveyancing Couriers Curtain and Blind Fitters Damp Proofing Installer Dance Instructors Data Cable Installers (ex trenching) Design Consultancy Desktop Publishing Services Disc Jockey Do It Yourself Retailers Dog Walking/Pet Sitting Domestic Appliance Installation & Repair Domestic Helps (Excluding nursing & care) Domestic Shed & Garage Erection Double Glazing Installation Drain Cleaners Drama Instructors Draught Proofing Installer Draughtsmen Dress Makers, Tailor or Curtain Makers Driving Instructor (Private Car Only) Drystone Wallers Ductwork Installers Electrical Contactors Electrical Engineers Engravers Estate Agents Exhibition Stand Erectors Face Painting Fencing Contractors Feng Shui Consultants Financial Advisory Service Financial Consultant/Adviser Financial Services Fire Equipment Supply & Maintain Fire Surround Installation Fitness Instructors Fitted Furniture Installers Flooring Contractors Flower & Plant Arrangers Food & Drink Distributors Fork Lift Truck Servicing Fork Lift Truck Training Instructors Freight Forwarders French Polishers Furniture Distributors Furniture Removals Furniture Repair or Restoration Garden Centres Gardeners (excl Landscaping) Glaziers Graphic Designers Graphologists Gravediggers Gutter Cleaners Guttering & Fascia Board Fitter Gym Equipment Installers Hairdressers Health & Safety Consultants Heating, Gas Fitters & Plumbing Contractors (Domestic Only) High Pressure Water Washing Contractors Home Clearance and Rubbish Removal Home Laundry and Ironing Service Home Tutoring House & Pet Sitters I.T Consultants Image Consultants Insulation Contractor Insurance Insurance Advisor Insurance Assessor Insurance Broker Insurance Consultancy Insurance Intermediary Interior Designers & Decorators Interpreter Investment Consultancy Investment Management Kerb & Paving Layers Kitchen Installers (Commercial) Kitchen Installers (Domestic) Landscaping Contractors Lawyers Leaflet Distributors Licensing Consultancy Lifestyle Consultants Light Haulauge Contractors Linguistics Locksmiths Loft Conversion Contractors Loft Insulation Contractors Loss Adjuster Loss Assessor Machine Dismantling Machinery Installation and Servicing Contractors Machinery Movement Management Consultants Market Research Consultants Marketing Consultancy Mastic Sealant Contractors Mechanical Engineering Medical Equipment Engineers Metal Fabricators (Premises) Metal Fabricators (work away) Milk Delivery Mobile Mechanics Mortgage Brokers Music Publisher Music Teacher Non-Manual Site Supervising Other Office Equipment Engineers Office Fitters Painters & Decorators (10m Height Limit) Pallet Distribution/Hire/Repair (Ex WWM) Pallet Manufacturer (Inc WWM) Paper Manufacturers Partitioning Contractors Party Planners & Wedding Organisers PAT Testers Paths, Drives & Patio Cleaners-Exclude Cleaning Of Buildings Paving Path, Drive and Patio Contractors Personnel Consultancy Pest Controllers Photographers (No Aerial Work) Photographic Developers (Print Labs) Piano Tuners Picture Framing Pipe Fitters Plant Hire (Mechanical Plant) Plasterers Plumbers, Gas Fitters & Heating Contractors (Domestic Only) Pools Collectors Potters Precision Engineers Printers Private Tutors Property Consultancy Property Letting Property Maintenance and Repair Property Management Public Relation Consultancy Public Relation Officer Publicity Management Quantity surveyors Racking and Shelving Installers Refrigeration Engineers Removals Contractor (Domestic & Office Only) Research Consultancy Restorers Roller Shutter & Door Installation Script Writing Sculptors Secretarial Services Security Guards (excluding Doormen) Shed/Garage Erectors Shopfitters Shot Blasters Sign Erectors / Sign Writers Sign Makers Silk Screen Printers Skip Hire Solar Panel Installation Solicitor Speech Therapist Sprinkler Installers excluding Heat Use Sprinkler Installers including Heat Use Stair Lift Installer (Domestic) Statisticians Stockbroking Stonemasons Street Furniture Installers Surveyors Tax Consultants Taxi Drivers Taxidermist Teachers Teachers (inc Manual Activities) Telecommunication Engineers Telecommunications Consultancy Telemarketing Telephone answering service Textile Consultancy Ticket agency Tillers (No Roofing) Timber Decking Contractors Training Consultants Translator Typewriter Services Typing and Copying Bureau Underwriting Agency Upholsterers UPVC Windows / Doors manufacture, ex installation Vacuum Cleaner Repairs & Servicing Valuer Vending Machine Engineers Ventilation Contractors Washing Machine Repair Waste Paper Merchants Water Treatment Engineers Web Site Design Wheelie Bin Cleaning Will Writing Window Cleaners (Domestic & Light Commercial Only) Window Cleaners (Water Pole Washing System) Woodworking Machinists Word Processing Yoga Instructors Public and Products Liability QuestionsPlease select the amount of cover required for Public LiabilityPlease select a value £100000020000005000000 What is your estimated UK turnover for the forthcoming year?Please enter a value Please state payments to Sub ContractorsPlease enter a value £ Do you undertake any work outside of the United Kingdom?Please answer Yes or No - Select - Yes No Do you export to countries outside of the United Kingdom?Please answer Yes or No - Select - Yes No Employers Liability CoverDo you require cover for Employers Liability Yes No Employers Liability £ Please give the estimated annual wage roll for the forthcoming year: ClericalPlease enter a value if applicable £ Payment to all manual employees and labour only sub contractorsPlease enter a value if applicable £ Fixed Woodworking MachinistsPlease enter a value if applicable £ WarehousemanPlease enter a value if applicable £ DriversPlease enter a value if applicable £ Key FactsWithin the last 5 years, 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 or had any claims made against you?Please answer Yes or No YesNo Claim DatePlease enter the date of the claim as dd/mm/yyyy 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Type of ClaimPlease select one of the available options - Select - Employers Liability Products Liability Public Liability - Bodily Injury Public Liability - Property Damage or Other Please provide details of the claim? Do you know the claim costs for this claim YesNo Total Cost or Amount OutstandingPlease enter a value Claim StatusPlease select one of the available options - Select - Settled Pending Repudiated Unknown Do or will you or your employees use heat away from your premises ( including welding or cutting equipment, blow lamps, blow torches, hot air guns and asphalt, bitumen, tar or pitch heaters )?Please answer Yes or No YesNo 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 of fumes, lifts, cranes, Hoists, slings, cradles or processes involving a noise level in excess of 85db?Please answer Yes or No YesNo Please provide full detailsPlease provide full details Do you or any of your employees work on, manufacture or sell products used in air or spacecraft, marine craft, offshore, in nuclear installations, in safety critical parts, motor vehicles or railways?Please answer Yes or No YesNo Please provide full detailsPlease provide full details If you have more than 5 employees you are required to have a formal Health & Safety policy and formal Safety Training Procedures Do you have more than 5 employees ? YesNo Do you have a formal written Health and Safety policy?Please answer Yes or No YesNo Do you have a formal safety-training plan for employees?Please answer Yes or No YesNo Do you have a documented procedure for high-risk activities? Please answer Yes or No YesNo Statement of Fact Please confirm that you and any of your partners or directors either personally or in connection with any business which you/they have been involved have ever: been declared bankrupt or are the subject of any current bankruptcy proceeding or any voluntary or mandatory insolvency or winding up procedures? YesNo been disqualified from being a company director? YesNo had a County Court Judgement or Sheriff Court Decree? YesNo ever been convicted of or charged with ( but not yet tried ) a criminal offence other that a motoring offence or a spent conviction in accordance with the "Rehabilitation of Offenders Act 1974"? YesNo been prosecuted or have prosecutions pending under the Health and Safety at Work Act or any other statute or regulation? YesNo Please provide full detailsPlease provide full details Cover Details Set - Trading Discount @ % £0.00 Set + Auto Load £ £0.00 Set + Total Load £ £0.00 Set - Trading Discount @ % £0.00 Set + Auto Load £ £0.00 Total Premium (Net) £0.00 + IPT @ % £0.00 + Policy Fee £ £0.00 Total Premium £0.00 Total Commission £0.00 (Due From Broker) £0.00
