Buildings & Allied Trades Liability Enquiry Form (fields with * are mandatory) Name of Client* Contcat Name(CLIENTS) Contact Tel No. Email Address Full Address Are You SoleTrader A main Contractor A Partnership A Sub Contractor A Limited Company Both Exact Business Description/Occupation Details of 2 contracts recently completed Details of 2 existing contracts Details of 2 future contracts Do you have premises?If so give details of work undertaken at premises Safety Statement Do you have a safety statement Yes  No Experience in Trade No of years in Business on own account  Yrs. Experience in trade with others  Yrs. Name of previous insurer,If any Renewal date Claims History (Records with empty Claim Year will not be saved.) Year Circumstances Paid Out Outstanding Employer Liability-Quote required Yes  No Estimated wages for the forthcoming insurance period Description No Wages Advised Wages Used Rates Premium Clerical *Clerical working directors *Manual working directors Manual employees (excluding woodworking operatives) Woodworking operatives All other employees Other Payments to labour only sub contractors *Include cover for working directors Yes  No Height Limit Depth Limit Standard 0-15 m 15-20 m 20-30 m 30 m+ Standard 0-3 m 3-5 m 5-8 m 8 m+ Products Liablity - Quote required Yes  No Est annual financial turnover If T/O includes landcosts - Advice Landcosts Estimated payments to sub contractors with own insurance, supplying their own materials Height Limit Depth Limit Standard 0-15 m 15-20 m 20-30 m 30 m+ Standard 0-3 m 3-5 m 5-8 m 8 m+ Burning & welding Do you use burning & welding equipment Yes  No  Work away Does work away apply Yes  No  If yes, % of work which is work away Limit of idemnity required required ROI NI 1,300,000 2,600,000 3,900,000 5,200,000 6,500,000 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 Contractors all risks - Quote required Yes  No  Maximum value any one contract Maximum length any one contract Estimated total turnover   Own Plant/tools/Spares/Site/Huts/Temporary Structures Estimated plant hiring charges Estimated plant hiring out charges Total premium Premium used additional_comments