Please fill in the form below as accurately as possible to get an online quote:- Your Details *mandatory field   First Name*:   Surname*:   House Number/Name*:   Address*:   City/Town*:   Postcode*:   Phone number (day)*:   Phone number (evening):   Best time to contact you: morning afternoon evening no preference Email*:   Occupation:   Marital Status: married single Date of birth*:     Liability Insurance Cover Details     Start date for policy*:     Company status: sole trader partnership limited company Trading name:   General Questions     1) Have you or any director or partner ever been declared bankrupt or insolvent? yes no 2) Have you or any director or partner;-     i) 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? yes no ii) been convicted during the past 15 years of any offence relating to health and safety of your employees or members of the public in connection with your business? yes no iii) convicted or is any prosecution pending for any offence involving dishonesty of any kind including for example, arson, fraud, theft, or handling of stolen goods? yes no 3) In respect of any of the risks against which you now wish to insure;-   i) has any previous insurer declined a proposal, refused to renew a policy or imposed special terms or conditions? yes no ii) have you or any director or partner suffered a loss / made a claim for any of the risks proposed exceeding £1,000 in the last 5 years? yes no   iii) have you or any director or partner suffered a loss / made a claim for 2 or more claims or losses within the last 5 years? yes no   Description of your Trade(s) or Business(es):   How many years' experience do you have in the trade? 1 2 3 4 5 6 7 8 9 10 11 - 20 more than 20 How many persons are involved in the primary trade activities of the business? 1 2 3 4 5 6 7 8 9 10 11 - 20 21 - 50 51 - 100 more than 100 Status of principle employees in the business: directly employeed labour only subcontractors working under government schemes directly employeed and lablour only all of the above Does you undertake work away from the premises involving any equipment for the application of heat: yes no Liability Cover Required     Amount of Public liability cover required: not required 1 million 2 million 3 million 4 million 5 million 6 million 7 million 8 million 9 million 10 million other amount Amount of Employers liability cover required: not required 1 million 2 million 3 million 4 million 5 million 6 million 7 million 8 million 9 million 10 million other amount Do you require Tool cover? yes no Do you require Goods In Transit cover? yes no     Please enter the number displayed above*: