Employer's Public & Products Liability
Contracting Trades
Full name of Proposer including all trading names, group companies and subsidiaries that are to be covered by the policy
Postal AddressOccupation / Business / Trade Description
PostCode
Address of premises to be insured if different from postal address
Postcode
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.
If you are registered for VAT any claim for loss or damage to property will be paid exclusive of VAT, and you are advised to arrange your sums insured accordingly. Allowance should be made to include an amount for VAT in the sum insured if you are not registered.
VAT Status/Registration No
 
1. Do you require a Quotation for:-
a) Employers Liability (not available on a stand alone basis)
b) Public Liability
c) Products Liability (only available with public liability)
For Public and/or Products, state limit of indemnity required.
Please tick
£ 1,000,000
£ 2,000,000
£ 5,000,000
£ 10,000,000
Other Limit of Indemnity required
£