General Details
1. Full Name of Business
2. Contact Name
3. Address of Premises
4. Postcode
5. Telephone Number
6. Fax Number
7. Email Address
8. Full Business Description
 
9. Do you outsource any work to third parties?
Yes No
If Yes
   a) what work is outsourced?
   b) do you check if the third parties have adequate insurance?
Yes No
 
10. If any work is undertaken away from the premises specified above please specify
   a) nature of work
   b) where such work takes place
   c) turnover generated from these aspects
£
 
11. Are the premises occupied by anyone other than you?
Yes No
If Yes, please provide full details
 
12.  Have you sustained any loss during the last five years which would have been covered by this type of insurance had it been in force?
Yes No
If Yes, please provide full details including date of incident, circumstances and amount claimed
Registered in England: Number 608819
Authorised and Regulated by the Financial Services Authority
Registered Office:
Lygon House, 50 London Road, Bromley, Kent. BR1 3RA