Title
- Choose -
Mr
Mrs
Miss
Dr
Name
Company Name
No & Street
Address 2
Town
County
Postcode
Email Address
quotes are sent by email
Telephone Number
Mobile Number
Business Status
Please Choose
Sole Trader
Partnership
Limited Company
Plc
Date Cover/Quote Required from
How long have you been in business?
New Start
One Year
Two Years
Three Years
Four Years
Five Years
Six Years
Seven Years
Eight Years
Nine Years
Ten Years+
How many years experience do you have in this trade or business?
New Start
One Year
Two Years
Three Years
Four Years
Five Years +
Do you operate your business from your home?
Yes
No
Annual Turnover
Principal Business
-Please Select-
Demolition - exc Asbestos
Demolition - inc Asbestos
Other - please specify below
Business Description - describe as fully as possible
Percentage of Work Involving Application of Heat.
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Do you undertake work on commercial/industrial premises excluding shops and offices?
No
Yes
Maximum Height Worked at
metres
Public Product and Employers Liability
Clerical Staff Numbers
Clerical Wages
Manual Staff Numbers
Manual Wages
Principals Directors
Direct Employees
Labour Only Sub Contractors
Bonafide Sub Contractors
Cover levels
Public and Products Liability
€2,600,000
€6,500,000
Employers Liability required?
€13M.
No
Yes
Claims / Loss Experience
Please give details of all losses whether insured or otherwise that have occurred in the last 3 years. If "none" state none
None
Any other comments that you feel may help our understanding of the business or that you feel may influence an underwriters opinion of the risk. Include details of any chemicals or processes that have been identified in any risk assessment undertaken.
Please note that an quotations will be subject to any appropriate health and safety and risk assessments having been completed and appropriate action having been taken.