Proposer Details
Proposer Name: *
Company Name: *
Type of Business: *
E-mail: *
Date of Birth
Please Select the Day, Month & Year you were born
Day: *
Please select
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Month: *
Please select
January
February
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December
Year: *
Please select
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Daytime Telephone Number: *
What Directed You To Our Website?:
Correspndance Address: *
Address to be insured if different: *
Company Status: *
Please select
Limited
Sole Trader
Partnership
Other
Do you have a separate business premises? *
Number of Employees: *
Number of years experience: *
Details of any criminal convictions for you or any other principal or director of the company:: *
Have you or any principal or director of the company had any policy cancelled, refused insurance or had terms imposed by any insurer or been declared bankrupt?
Details of claims history:
Nature of work undertaken:
Type of premises worked on:
Maximum height worked at: *
Maximum depth below ground level worked at: *
Estimated annual turnover: *
Does your work involve any element of design or consultancy? *
Please provide details of any tempoary employees:
Please provide details of any sub contractors:
Cover Options
Public Liability: *
Please select
1 Million
2 Million
5 Million
Do you require cover for tools? *
If yes please confirm overall value, highest value of any one item:
Are tools kept in a van overnight? *
If yes, is the van garaged or in a locked compund?
What level of security does the van have?
Do you require cover for any plant or machinery? *
If yes, is this own plant or hired in plant?
What is the total value and single article limit?
Do you require cover for contract works? *
If yes, what is the contract value required?
Do you require cover for any stock or business equipment other than hand held tools? *
If yes, please provide details:
Please provide details of any other cover required:
Terms & Conditions
I understand Ryan Insurance Group use a select panel of insurers for this type of business
My quotation will be valid until the end of the current month
I am obliged to provide all material facts that may affect the rating or acceptance of the policy, as failure to do so could invalidate my insurance cover
Ryan Insurance Group is obliged by law to give me the opportunity to hear how they give advice, deal with compensation and handle complaints. This information is contained within their terms of business agreement (attached).
Agreement
I have read and agree to the terms and conditions above: *