Welcare Cover Proposal Form
Please answer all the questions for each of the relevant sections as fully as possible.

Incorrect answers or failure to disclose all material facts may render the insurance inoperative. Material facts are those which would influence acceptance or assessment of the insurance risk. If you are in doubt, please disclose them or seek assistance from your insurance representative.

 
Full name of Proposer including all group companies and subsidiaries that are to be covered by this policy
Business premises address
Post Code
Tel No.
Email
Fax No
 
 
Postal Address
(if different from above)
Post Code
Tel No.
The Business
Please give full description of the business and the nature of the services provided, including age range of residents.
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.
   
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