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

Client Details

General Information Details

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

  • Please provide details of your current insurer

    year(s)
  • Do your own contract conditions or your customer’s contract conditions increase your normal legal liabilities?

  • 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 public liability insurance and keep copies

    Has any insurer ever declined to insure you, cancelled or refused to renew your insurance

  • Have you or any director or partner ever:

    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?

    Been concerned with any business which has been wound up, liquidated, dissolved or ceased to trade?

    Been involved as an owner, director or partner of any other business in the last 5 years?

    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 give any professional advices in return for a fee? (i.e. venue risk assesment)

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

    Are you involved in crowd control, protestor sites, close protection, special event work or similar activities?

Claims

Have you made any claims in the last 5 years?

1

£

2

£

3

£

4

£

5

£

Cover Required

  • Public Liability

    Products Liability

    Employers Liability

    Professional Indemnity

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 2015

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