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
     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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Registered in England: Number 608819
Authorised and Regulated by the Financial Services Authority
Registered Office:
Lygon House, 50 London Road, Bromley, Kent. BR1 3RA