1. Employers Liability
Is cover required for Employer's Liability?
Yes  No
If Yes, please provide the following details:
  Type of Employee
Number
Estimated Wages
  Clerical/Managerial
  Close Protection Officers
  Others
a) Sub Contractors:
   (i) Do you employ any Sub Contractors? (If Labour only please include under Employers Liability section
Yes  No
   (ii) Do you ensure that Sub Contractors maintain Employers Liability and Public/Products/Products Efficacy Liability Insurances with Limits of indemnity no less than the Limits Proposed under this Insurance
Yes  No
   (iii) Estimated Annual Payments to Bona-Fide Sub Contractors
£
2. Public Liability
Is cover required for Public Liability?
Yes  No
What limit of indemnity do you require?
Annual estimated turnover
£
3. Personal Accident
Is cover required for Personal Accident?
Yes  No
(a) Number of persons to be insured
(b) Are you and your staff physically fit and in good health?
Yes  No
If No, please provide brief details