Get a Quote Morgan Law Insurance You may to choose to complete all or selected fields depending on the level of cover you require.

Transcription

1 Get a Quote Morgan Law Insurance You may to choose to complete all or selected fields depending on the level of cover you require. Your details First Name* Last Name* Telephone : Mobile : Your * Details of the Business to be insured Company Address Line 1 Address Line 2 City Postcode Website Turnover Employees Trading Since Business Description Cover required Cover Required Renewal Date Date Required Holding Broker Holding Insurer Target Premium Long term agreement Details of the cover required Public and Products Indemnity Types of Products/Services provided Special Conditions Trade/Professional Association Health and Safety Scheme Do you hold accreditations for Environmental management (ISO series) Other such as Investors in People Do you have a written Health and Safety

2 Policy Employers Indemnity Limit Estimated payroll information Clerical/Administrative Director(s) - n manual Director(s) - Manual Manual - Premises Manual - Work away Bona fide sub-contractors (BFSC) Drivers Wood working machinery and/or other power driven machinery Employees Wages Claims details Claims History Other supporting information Other relevant information Further Details Legal status of the Proposer Proposer's name in full Specify any additional trading names other than those listed above Address of the Business Address Line 1 Address Line 2 City County Postcode

3 Further details of the Business to be insured Full Business description Trade selected Does the Proposer carry out any activities that are different to the trade selected? Does the Business trade from any additional locations? In which year did the Business start trading? (YYYY) The working procedures for the Business Are the Proposer's ways, works, machinery and plant properly fenced and otherwise in good order and regularly inspected to comply with statutory requirements? Is smoking allowed on the Business premises (select '' if Business premises)? Does the proposer have; a) a formal written Health and Safety policy (select 'Yes' if less than 5 employees where this is t required)? b) a formal safety training plan for employees (if E.L. required)? c) a documented procedure for high risk activities (if applicable)? d) a formal documented accident investigation plan? What percentage of total turnover does this represent for; a) on the premises? b) away from the premises? Does the Proposer contract work to any sub-contractor? Are these contracts with; a) labour only sub-contractors (LOSC)? b) bona fide sub-contractors (BFSC)? Does the Proposer require the sub-contractor to carry relevant Employers', Public and Products Liability insurance (at a similar Limit of Indemnity to this proposal) and are satisfied that this insurance is in place? Does the Proposer or any of its employees carry out any manual work (other than collection and delivery) away from the Business premises? What percentage of the TOTAL turver is work carried out at the following locations; a) Private Dwelling HousesPrivate dwelling houses only b) Commercial BuildingsFlats, Shops, Public Houses, Schools, Restaurants and Offices only

4 c) Industrial BuildingsFactories, Warehouses, Agricultural, Quarries, Hospitals, Hotels, MOD or Other Please provide full details of these locations worked at Does the Proposer or any of its employees engage in any work outside the United Kingdom? Hazardous Activities Does the Proposer or any of its employees use, handle, transport or work in/on any of the following; If yes - Provide full details of exposure and the precautions taken? a) radioactive substances or devices? b) explosive substances? c) asbestos or silica or material containing these substances? d) toxic or hazardous chemicals? e) any materials giving rise to dust or fumes? f) processes involving a ise level in excess of 85db? g) demolition? h) bridges, piers, docks, viaducts, towers, steeples, chimney shafts or blast furnaces? i) underpinning, pile driving, quarrying, tunnelling or mines? j) aircraft (or airside work)? k) ships, boats, hovercraft, docks, wharves, railways, offshore installations, rigs or platforms? l) heights exceeding 15 metres?

5 m) depths exceeding 0.5 metres? n) cranes, cradles, slings or similar apparatus? Sections of cover required: Employers' Liability? Public Liability? (This is required on all policies, unless specifically agreed by Underwriters) Product's Liability? Does the proposer manufacture, supply or distribute; a) any product used in aircraft, aerospatial device, motor vehicle, hovercraft, or waterbourne craft or marine, motor or aviation purposes? b) fertilisers, pestcides, fungicides and/or animal feeds? c) pharmaceutical, medical, cosmetics, beauty aids and/or blood products? d) chemicals/petrochemicals or any other substance of an explosive, toxic or xious nature? e) genetically modified organisms and/or seeds and/or products containing genetically modified organisms? f) tobacco products? g) asbestos products? h) tanning machines, toys and/or mobile telecommunication equipment? i) firearms and munitions? Estimated turver for the period of insurance proposed, split by territory: U.K. U.K. - Bona fide sub-contractors (BFSC) Other European Union U.S.A. and/or Canada Other Limits of Indemnity required: Employers' Liability Public Liability Product's Liability Third party property damage excess required: Excess for each and every event Files attached (e.g.claims history, motor fleet schedules, policy documentation)