Camberford Law PLC

Part 1: Business Details

Proposer’s Full Name including all trading names, group companies and subsidiaries that are to be covered by the policy

Address
(including post code)

Contact Name

Telephone Number

Fax Number

E-Mail Address

Website Address

3. Please list the names, dates of birth and background of all the Company Directors/Partners including number of years experience in the industry

4. 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)

5. If you do not have a PAYE Reference, please confirm that you are exempt and give the reason.

Are sales made over your website?

Yes No

Full Business Description and Nature of Holidays Provided

Year Established

If a new venture, you will be asked to provide CV's for the Principle(s)

How long have you been in business elsewhere?

Please list any Trade Association you belong to:	ABTA	BITOA
	ABTOF	ARTAC
	NAITA	AITO

Current Insurance	Renewal Date
	Insurer
	Premium	Liability	£	Office	£

Guidance Notes

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.

Full Business Description
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. Event Organisation, Dynamic Packaging etc.

T: 020 8315 5000

F: 020 8460 2118

E: mail@camberfordlaw.com