General Questions
Please answer all the questions for each of the relevant sections as fully as possible. Incorrect answers or failure to disclose all material facts may render the insurance inoperative. Material facts are those, which would influence acceptance or assessment of the insurance risk. If you are in doubt, please disclose them or seek assistance from our insurance representative.
 
Full name of Proposer including all trading names, group companies and subsidiaries that are to be covered by this policy
Business Premises Address
Postcode
Telephone No
Email Address
Postal Address (if different from above)
Postcode
Telephone No
 
Period of Insurance
   from
   to
Please list names and dates of birth of all Directors/Partners
If you require Employers’ Liability cover, please supply your Employer PAYE Reference(s). (This information is required for us to provide Employers’ Liability cover. Where you have more than one PAYE Reference, please advise each one making it clear which company they apply to)
If you do not have a PAYE Reference, please confirm that you are exempt and give the reason.