Combined Contractors Liability
The Data Capture
Multi Section Questions
Broker ID *
Insured
Post Code
Address
Trade
(please select one)
Air Conditioning Contractors
Alt/Repair/Maint PDH
Alt/Repair/Maint Other
Bathroom Fitters
Carpenters/Joiners
Demolition Contractors
Electrical Contractors PDH
Electrical Contractors Other
Fencing Contractors
Flooring Contractors
General Builders New PDH
General Builders New Other
Groundworkers
Kitchen Installers
Landscape Gardeners
Painters/Decorators PDH
Painters/Decorators Others
Plasterers
Plumbing & Heating PDH
Plumbing & Heating Other
Roofers
Scaffolding Contractors
Shop/Office Fitters
Tiling Contractors
Turnover
Heat Work
Yes
No
Percentage of turnover
Type
(please select one)
Hot Air Guns only
Blowlamps
Oxyacetylene Welding etc.
Height Limit (metres)
Depth Limit (metres)
(please select one)
1 metre
3 metre
5 metre
10 metre
Inception Date
Specific Questions: Employers Liability
Wages
Clerical
Non Manual
Manual
Labour only sub contractors
All Others
Specific Questions: Public Liability
Indemnity Limit
(please select one)
£1,000,000
£2,000,000
£3,000,000
£5,000,000
£10,000,000
£15,000,000
£20,000,000
£25,000,000
Payments to Bona Fide Sub contractors
Number of premises
Specific Questions: All Risks
Limits
Maximum any one contract
Own Plant - any one item
Hired in plant - any one item
Other
Value of own plant
Hired in charges
Other Total
Terrorism
Yes
No
Claims within 5 Years
Yes
No
Current Insurers
Target Premium
Additional Info
* You must supply your registered Broker ID e-mail address.
tel
020 7553 5950
fax
020 7680 9524
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