Exclusively for insurance brokers


Liability
quotation form . . .



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Liability Quotation Form

  Broker
Contact Name  
Broker Name  
Address  
Postcode  
Phone  
Fax
E-Mail  
 
  Proposer
Full Name
Age
Trading Name
Business Address
Postcode  
  About the Business
Business Type
Annual Turnover   £
Year Established   
 
  Trading From - must add up to 100%
Home    %
Premises    %
Mobile    %
  Cover Required
Public Liability
Sales & Service Indemnity
Tools Cover per Person
Cover tools away from premises
Employers Liability (Limit £10m)
Sub-Contractors
How many Labour Only? How many Bona Fide?
  Previous Insurance Details
Insurer
Expiry Date
 
Policy No.
 
   
Previous Liability Claims
  What You Do - must add up to 100%
Accessory Fitting - New    %
Auto-Electrician    %
Crash/Body Repairs    %
Exhaust Fitter    %
LPG Conversions    %
Mechanical/Service    %
MOT Tester    %
Recovery    %
Smart Repairs    %
Tyre Fitter    %
Valeting    %
Vehicle Sales    %
Other (please specify)   
%
 
  What You Do It To - must add up to 100%
Cars & Light Commercial    %
Classic/Vintage Vehicles    %
CV 3.5 tons to 7.5 tons    %
Kit Cars    %
Left-Hand Drive    %
Minibuses up to 15 seats    %
Modified    %
Motorcycles    %
Plant & Agriculture    %
Sports/High Performance    %
Trailers/Caravans    %
Trikes & Quads    %
USA/Canadian    %
Other (please specify)   
%
  The Proprietors, Partners, Directors and Employees
No. Full Name Date of Birth Status Manual/Clerical
1
 
Proprietor/Director
2
 
3
 
4
 
5
 
6
 
No. Cover Required Years in
Motor Trade
Annual
Wage/Drawings
Family Member
1
  PL EL Tools  
N/A
2
  PL EL Tools  
3
  PL EL Tools  
4
  PL EL Tools  
5
  PL EL Tools  
6
  PL EL Tools  
  Heat Work Carried Out
Angle Grinders
Blow Lamps/Hot Air Guns
Welding and/or Cutting Equipment
 
  % Turnover from Heat Work
On the Premises    %
Away from the Premises    %
  Full Time or Part Time
If Part Time, state Other Occupation
  Material Facts
  Important Information
For all quotations, we will assume that the above mentioned:
  • Has a business based solely in the UK.
  • Does not deal with rally, track or race cars
  • Do not deal with HGVs, Buses or Coaches.
  • Is not involved in self drive hire, auctions, vehicle assembly, car jockey, parts delivery, import or exports.
  • Has not suffered more than one loss or a claim for more than £10000 in the last 5 years.
  • Has never been declared bankrupt or insolvent as a private individual or in connection with any business.
  • Has never been convicted or charged with but not yet tried for a criminal offence.
  • Has works, machinery and plant fenced, in good working order and regularly inspected.
  • Has undertaken risk assessments.
  • Has a written Health & Safety policy if more than 5 employees and a formal safety training plan.
  • Has waste disposed of only at Council approved sites.
  • Has no processes which might cause pollution or contamination.
  • Does not undertake any hazardous activities i.e. radioactive substances or devices, toxic or hazardous waste / chemicals, explosive substances, asbestos, silica or material containing these substances, any materials giving rise to dust or fumes, processes involving a noise level in excess of 85db. Please attach a separate sheet detailing full exposure and full precautions taken.
  • Has not entered into any wider contractual liabilities than they would under common law.
  • Has not had a previous policy cancelled refused declined or terms &/or conditions imposed.