Combined Liability
Professional Indemnity
Contractor's All Risks
High Risk Liability
Excess Layer
   
 

Scaffolders, Roofers, Hot Roofers, Steel Erectors, Steel Fabricators

PROPOSER

Full Name (including trading name)

  *  

Business Name:

  *  

Address:

   *
Postcode:   *
Email Address:   *
Website Address:   *

Are you
(please select one)

 
Sole Trader Partnership Limited Company * 
Business Description:   * 
In which year did the business start trading?   * 

Turnover?

   * 

USE OF HEAT

   

Do you or any employees engage in the application
of heat?

Yes No *  

If yes, what % of the turnover is use of:
     
a) Soldering irons   %
b) Blow lamps   %
c) Welding, cutting, grinding equipment   %

What percentage of the TOTAL turnover is work carried out at the following locations;

a) Private Dwelling Houses:  
Private dwelling houses only  

b) Commercial Buildings:

   
Flats, Shops, Public Houses, Schools, Restaurants
and Offices only

c) Industrial Buildings

   
Factories, Warehouses, Agricultural, Quarries, Hospitals,
Hotels, MOD or other

If industrial, please advise what type of buildings are worked on

  

Does the Proposer or any of its employees use, handle, transport or work in/on any of the following:

a) heights exceeding 15 metres?

 
Yes No
*  
If yes, to what height limit  

b) depths exceeding 0.5 metres?

 
Yes No
*  

If yes, to what depth limit

  

Number of Employees for the period of insurance proposed for the following categories:

    Number of employees Estimated Wages

Clerical/Administrative

 
Director - non manual    
Director - manual  
Manual - premises  
Manual - work away  
Drivers    
Labour Only Subcontractors  
Bonafide Subcontractors    
       
 

Limits of Indemnity required:

    £1m £2m £5m £10m

Public Liability

     
Products Liability        

Employer's Liability

 
Yes No
*  
   
If yes, please supply ERN NUMBER  

Does the proposer or any of their employees engage in any work outside the UK?

Yes No
*  

Does the proposer carry out any activities that are different to the trade above?

Yes No
*  

If yes, please state the full business activities

  

 

Has the insured suffered a loss, claim or incident in the last 5 years?

Yes No
*  

If yes, please give details

  
Has the proposer or any partners or directors ever:

A) Had any proposal or insurance cancelled or has any Insurer ever declined to renew their policy or required increased premium or imposed special terms?

Yes No
*  

B) Been prosecuted or any prosecutions pending under the health and safety at work act or any other statute or regulation?

Yes No
*  

C) Been convicted of, prosecuted for/or are prosecutions pending for any criminal offences other than motoring convictions?

Yes No
*  

BROKER CONTACT DETAILS

Contact Name

   *  

Contact Tel Number

  *  

Contact Email

  *  
* = required field

Terms and Conditions

Copyright © 2009 Hensure Underwriting | Terms & Conditions | Terms of Business. Hensure Underwriting is a trading name of RK Henshall & Co Ltd. RK Henshall & Co Ltd are authorised
and regulated by the Financial Services Authority. Registration Number: 308865. www.fsa.gov.uk. Written quotations, policy terms, conditions and exclusions are available on request.