Cover Secure

01737 669483

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Please fully complete the form below as accurately as possible to ensure we can provide you with the best possible quotation. Fields marked with * (asterisk) are mandatory.

Client Details

  • Does your business have any subsidiary companies?

    Is the company exempt from requiring an HMRC PAYE Employers Reference Number?

General Information Details

  • What is most important to you regarding the insurance you are looking to arrange?

  • Please provide details of your current insurer

  • Do you undertake or supply work:

    Outside Great Britain

    In Northern Ireland

    At a height in excess of 16 meters

    On board ships, on off-shore installations, at airports, chemical or petrochemical works, nuclear Installations, bulk oil or gas storage facilities or within 5 meters of railway tracks

    At mainframe computer sites

    Do you engage Bona Fide subcontractors

    If yes do you check subcontractors hold appropriate public liability insurance and keep copies

  • Have you or any director or partner:

    Held an SIA Licence for at least the last 12 months?

    Ever had insurance declined, cancelled or renewal refused?

    Been prosecuted under the Health & Safety at Work Act 1974, the Consumer Protection Act 1987 or any other legislation relating to the health & safety of your employees?

    Been convicted of or charged (but not yet tried) with a criminal offence other than a motoring offence?

    In the last 5 years been concerned with ANY business which has been wound up, liquidated, dissolved or ceased to trade?

    In the last 5 years been involved as an owner, director or partner of ANY OTHER security related business?

  • Are all relevant employees licensed by the SIA?

    Do you vet in accordance with British Standards relevant to the security sector?

    If Yes, please tick which British Standard(s) you adopt

    Do you have a system in place for ensuring guards/door supervisor & stewards are on duty on site at the required time?

    Do you provide Door Supervisors that will operate alone (one man doors)

    Do you provide any ancillary non-guarding activities such as industrial/commercial processes or monitoring machinery?

    Are you involved in crowd control at protestor sites or similar activities?


Have you been involved in any incidents, suffered any losses or made any claims in the last 5 years for any of the covers requested?











Cover Required

  • Public and Products Liability

    Employers Liability

    Professional Indemnity

    Inefficacy and Contractual Liability

Estimated Turnover Figures for the coming 12 months - Net of VAT for all your business activities

  • £

Additional Information

Other Details

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© Coversure Insurance Services 2020

Mr Jeremy Burgess trading as Coversure Insurance Services (Reigate) is authorised and regulated
by the Financial Conduct Authority. Ref: 307359.