| Title |
|
| Name |
|
| Company
Name |
|
| No & Street |
|
| Address |
|
|
Town |
|
| County |
|
| Postcode |
|
|
Email Address |
quotes
are sent by email |
|
Telephone Number
|
|
Mobile Number |
|
|
Contract Price (£) |
|
Date Cover/Quote Required from
|
|
Please provide details of the contract including the
address, the type of property, contract length etc. |
|
|
Sums Insured and Cover - the following sums insured and
limits are standard under the contract, if you require
other limits please specify the required limit. |
|
Employers Liability - €13,000,000 |
|
|
Public Liability - €2,600,000 |
|
|
Value of Own Plant (including tools, equipment, and
temporary buildings) - €26,000
|
|
|
Hired in Property? - €26,000 |
|
|
Additional Covers |
|
|
Total Value of Employees' Tools to be Covered (Max
Limit €500 any one employee):
|
|
|
Value of existing structures |
|
|
General Information |
|
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Is there an appointed Safety Officer, or a person
clearly responsible for Health & Safety Issues?
|
|
|
Is the contract address in an exposed position to
storm/flood (e.g. within 250 metres of sea
front/watercourse?
|
|
|
Are 100% of the premises and outbuildings being
constructed from brick, stone, or concrete, with no
combustible internal panels, and roofed with slates,
tiles, concrete, metal or asbestos, and with no more than
25% of the total roof area being felt on timber?
|
|
|
Will you occupy the residence upon completion? |
|
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Please give details of all losses whether insured or
otherwise that have occurred in the last 3 years. If
"none" state none |
|