Products & Services
Proposer Name: (Please include trading and partners names if not a Limited Company)
Full Business Address including Postcode
Date Insurance to Commence
How long have you been in business at this address?
Are you a member of any Trade Association?
If Yes please provide further details including membership number:
How many persons do you employ
If you require Employers’ Liability cover, please supply your Employer PAYE Reference(s). (This information is required for us to provide Employers’ Liability cover. Where you have more than one PAYE Reference, please advise each one making it clear which company they apply to)
If you do not have a PAYE Reference, please confirm that you are exempt and give the reason.
Do you require this cover?
We will automatically provide you with a limit of £10,000,000
If an increased limit is required please indicate
a) Please indicate limit of indemnity required
or Other limit (please state amount)
b) Do you manufacture or supply 'own branded' cleaning consumables or equipment?
If 'yes' please provide details:
c) What is your estimated turnover for the supply of consumables?
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Please answer all questions fully and carefully. There is a duty to disclose all material facts. Material facts are those that affect the judgment of a prudent Underwriter.
The proposal form and the information you provide forms the basis of the insurance policy you are purchasing and therefore is extremely important. Full disclosure should eradicate many issues at the time of a claim being made on the policy.
Full Name of Proposer
If a Limited Company please insert this name in the full name of the Proposer.
If a sole trader – please list your name in the full name of the Proposer and any Trading Name below this.
If a partnership, list all partners’ names in Full Name of Proposer and any Trading Name in the next box.
Please make sure that you list every activity you undertake to ensure we cover your activities correctly and prevent any issues at the time of making a claim ie. Window cleaning, carpet cleaning
T: 020 8315 5000
F: 020 8460 2118
© 2010 Camberford Law PLC. All Rights Reserved
Registered in England and Wales: No 608819
Authorised and regulated by the
Financial Conduct Authority
50 London Road
Kent BR1 3RA
Tel: 020 8315 5000
Fax:020 8460 2118