Camberford Law PLC

General

Full name of Proposer including all trading names, group companies and subsidiaries to be covered by the policy

Risk Address

Correspondence Address (If different)

Telephone Number

Email Address

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.

Renewal Date / Date from which cover is required

Current Insurer and expiring/target premium

Insurer

Renewal/Target Premium

Reason for Marketing Risk

Full Business Description

VAT Status/Registration Number

Number of years trading from this Premises

Years

Number of Years Experience within this or an associated indsutry

Years

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 list any further activities provided for your guests to ensure we cover your activities correctly and prevent any issues at the time of making a claim, ie. Gymnasiums, swimming pools etc.

T: 020 8315 5000

F: 020 8460 2118

E: mail@camberfordlaw.com