Quotation Request for Tradesman

Personal Details Title Doctor Miss Mr Mrs Sir * Full Name * EMAIL ADDRESS * Telephone * Trading Name * Primary risk trade / industry Accoustic Engineer Aerial Erector Agricultural Contractor Air Conditioning Engineers Alarm Installer Artexer Awnings Bath Resurficers Bathroom Fitting Boiler Services (Domestic) Bricklayer Builder Caretaker Carpenter & Joiner Carpet & Upholstery Cleaners Carpet Fitters Caterer Cavity Wall Insulators Ceiling Contractors Ceiling,Wall & Floor Tiler Chimney Flue Installers Chimney Sweep Cleaners (Industrial) Cleaning Contractors Conservatory & Porch Erectors Conveyancing Curtain & Blind Fitters Damp Proofing Contractors Data Cabling Decorative Leadwork Domestic Appliance Engineer Domestic Stair Lift Installers Domestic Wheelie Bin Cleaners Door Entry System Installer Double Glazier Draft Proofing Installer Drain Cleaner Drive Laying Dry Liner Drystone Wallers Ductwork Installation Electrical Appliance Servicing Electrical Contractor Electrical Installation Electrical Testing Electronic Tagging Exhibition Stand Erector Fencing Contractors Financial Market Trading Fire Surround Installation Floor Screeding Flooring Contractor French Polisher Furniture Installers Furniture Repairers Garage & Shed Erectors Gardeners Gas Fitters Gate/Garage Door Fitters Glaziers Graveyard Maintenance Groundworker Groundworker (paving & Drives) Guttering & Facia Board Fitter Harling and Roughcasting Heating Engineer Industrial Electrician Inventory Clerk Investment Banking Joiner Kitchen Installer Landscape Gardener Lift Contractors Lock Fitting Locksmith Loft Conversions Loft Insulation Mastic Sealant Contractors Metal Stud Work Mezzanine Flooring Monumental Masons Office Equipment Repairers Office Fitters Painters & Decorators Painters of Murals Partitioning Contractors Paving & patio contractor Pebble Dashing Plasterers Plumber Property Maintenance & Repair Refrigeration Engineer Rendering Roller Shutter Door Installation Roofer (cold) Safe Engineer Satellite Dish Installer Sawyer Security Camera Installer Security Lighting Installers Shed Erectors Shelving Erectors Shopfitter Shower Installation Sign Installer Sign Writer Site Clearance & Excavation Smoke Alarm Installers Soft Furnishing Maker Stained Glass Windows Steam Cleaners Stone Mason Swimming Pool Contractor Telegraph Pole Erectors Telephone System Installers Textured Coatings Timber Decking Contractors Upholsterer Window & door fitters Window Cleaners * Secondary risk trade / industry None Accoustic Engineer Aerial Erector Agricultural Contractor Air Conditioning Engineers Alarm Installer Artexer Awnings Bath Resurficers Bathroom Fitting Boiler Services (Domestic) Bricklayer Builder Caretaker Carpenter & Joiner Carpet & Upholstery Cleaners Carpet Fitters Caterer Cavity Wall Insulators Ceiling Contractors Ceiling,Wall & Floor Tiler Chimney Flue Installers Chimney Sweep Cleaners (Industrial) Cleaning Contractors Conservatory & Porch Erectors Conveyancing Curtain & Blind Fitters Damp Proofing Contractors Data Cabling Decorative Leadwork Domestic Appliance Engineer Domestic Stair Lift Installers Domestic Wheelie Bin Cleaners Door Entry System Installer Double Glazier Draft Proofing Installer Drain Cleaner Drive Laying Dry Liner Drystone Wallers Ductwork Installation Electrical Appliance Servicing Electrical Contractor Electrical Installation Electrical Testing Electronic Tagging Exhibition Stand Erector Fencing Contractors Financial Market Trading Fire Surround Installation Floor Screeding Flooring Contractor French Polisher Furniture Installers Furniture Repairers Garage & Shed Erectors Gardeners Gas Fitters Gate/Garage Door Fitters Glaziers Graveyard Maintenance Groundworker Groundworker (paving & Drives) Guttering & Facia Board Fitter Harling and Roughcasting Heating Engineer Industrial Electrician Inventory Clerk Investment Banking Joiner Kitchen Installer Landscape Gardener Lift Contractors Lock Fitting Locksmith Loft Conversions Loft Insulation Mastic Sealant Contractors Metal Stud Work Mezzanine Flooring Monumental Masons Office Equipment Repairers Office Fitters Painters & Decorators Painters of Murals Partitioning Contractors Paving & patio contractor Pebble Dashing Plasterers Plumber Property Maintenance & Repair Refrigeration Engineer Rendering Roller Shutter Door Installation Roofer (cold) Safe Engineer Satellite Dish Installer Sawyer Security Camera Installer Security Lighting Installers Shed Erectors Shelving Erectors Shopfitter Shower Installation Sign Installer Sign Writer Site Clearance & Excavation Smoke Alarm Installers Soft Furnishing Maker Stained Glass Windows Steam Cleaners Stone Mason Swimming Pool Contractor Telegraph Pole Erectors Telephone System Installers Textured Coatings Timber Decking Contractors Upholsterer Window & door fitters Window Cleaners * Postcode, e.g. WR2 6NJ * Cover start date, dd/mm/yyyy * Must be completed to proceed

Client Info
Present insurer	Please select... AIG Allianz Insurance Plc AXA Insurance Company Limited CNA International Insurance Company, Birmingham Ecclesiastical Insurance Office Plc Folgate Insurance Company Limited Fortis Insurance GE Frankona Groupama Insurance Company Ltd Liberty Motor NIG None Other Prudential Assurance Company Plc RSA Travelers Insurance Company Limited Zurich Insurance Company
Are you a Limited Company?	No Yes
Total number of manual employees, including labour only contractors ( and manual Director if limited company )?
How many partners, principals work manually (including youself) ?
How many NON MANUAL employees do you have?
How many NON MANUAL partners, principals directors are there?
How Long have you been established? (In Years)
How many years experience do you have?

Cover
What Public Liability Limit do you require?	Please select... 1000000 2000000 5000000
Do you require tools cover?	No Yes
What value of tools cover would you like?	Please select... 1250 1500

Safety
Are you a member of any association or federation?	No Yes
Do you have anyone who is responsible for Health and Safety?	No Yes
Do you have anyone who is responsible for written risk assesments?	No Yes
Does your plant get inspected by a qualified contractor?	No Yes

Conditions
Do you work solely on Private Dwelling Houses, Offices, Shops only	No Yes
Do you use any Fix powered woodworking machinery?	No Yes
Do you use Heat?	No Yes
What is the max height you work at? (In metres)

Claim Details
Have you had any Public or Employers Liability or tools claims in the last five years	No Yes
* Must be completed to proceed

You :
1.	No proposer, director or partner of the business or practice has ever been declared bankrupt/insolvent, or the subject of bankruptcy proceedings, or been the subject of a County Court Judgement (or the Scottish equivalent
2.	You are not involved in demolition other than as part of a contract to rebuild by you
3.	You do not work with silica, asbestos or substances containing asbestos nor do you work with acids, gases, explosives, radioactive or similar dangerous liquids or chemicals.
4.	You do not work on power stations, nuclear installation or establishments, refineries, bulk storage or premises in oil, gas or chemical industries or offshore structures.
5.	You do not work on aircraft, hovercraft, aerospace systems, watercraft, railways, underground or underwater
6.	No insurer has cancelled, declined to renew or declined to provide cover in respect of you or your partners or directors
7.	You or any partner or director have never been convicted for any criminal offence involving dishonesty, arson, theft or wilful damage or for a breach of any stature relating to health and safety at work or has any prosecution pending or outstanding.