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General
Proposer Name: (Please include trading and partners names if not a Limited Company)
Full Business Address including Postcode
Tel. No
Fax. No
Email Address
Business Description
Date Insurance to Commence
Date Established
How long have you been in business at this address?
Elsewhere?
Are you a member of any Trade Association?
Yes
No
If Yes please provide further details including membership number:
How many persons do you employ
Employers Liability
Do you require this cover?
Yes
No
We will automatically provide you with a limit of £10,000,000
If an increased limit is required please indicate
£
Public/Products Liability
a) Please indicate limit of indemnity required
£1,000,000
£2,000,000
£5,000,000
or Other limit (please state amount)
£
b) Do you manufacture or supply 'own branded' cleaning consumables or equipment?
Yes
No
If 'yes' please provide details:
c) What is your estimated turnover for the supply of consumables?
£
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Guidance Notes
Please answer all questions fully and carefully. There is a duty to disclose all material facts. Material facts are those that affect the judgment of a prudent Underwriter.
The proposal form and the information you provide forms the basis of the insurance policy you are purchasing and therefore is extremely important. Full disclosure should eradicate many issues at the time of a claim being made on the policy.
Full Name of Proposer
If a Limited Company please insert this name in the full name of the Proposer.
If a sole trader – please list your name in the full name of the Proposer and any Trading Name below this.
If a partnership, list all partners’ names in Full Name of Proposer and any Trading Name in the next box.
Business Description
Please make sure that you list every activity you undertake to ensure we cover your activities correctly and prevent any issues at the time of making a claim ie. Window cleaning, carpet cleaning
T: 020 8315 5000
F: 020 8460 2118
E:
mail@camberfordlaw.com