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LEC
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OLICY
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ROPOSAL
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Please answer all questions, completing the form in ink using block capitals.
The completion and signature of this Proposal does not bind the Proposer or Insurers to complete a contract of insurance.
Please note that you must disclose all material information likely to influence the acceptance and/or assessment of your Proposal. If you are unsure whether any item of information is material you should include it. A failure to do so may give the Insurers the right to refuse the claims which you make, and in certain circumstances to avoid the Policy altogether.
Proposer’s Full Name
Include all subsidiary companies to be insured
If the Proposer is not a limited company specify any trading names and the names of all principals and partners.
Address Tel
Fax
Post Code e-mail
BUSINESS DETAILS
1. When was the business established?
2. Have you ever traded under a different name? YES NO
If “YES”, please advise details:
3. Are you engaged in business solely as an electrical contractor or electrician? YES NO
If “NO”, what is your full business description?
4. Are you
i a member of the Electrical Contractors’ Association? YES NO
ii a member of SELECT? YES NO
iii an NICEIC approved electrical installation contractor? YES NO
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5. What is your estimated Gross Annual Turnover for the next twelve months?
i Electrical contracting £
ii All other contracting £
iii All other turnover £
6. Indicate as a percentage of your Gross Annual Turnover, the extent of work in the following areas
i Domestic %
ii Commercial %
iii Industrial %
7. Indicate as a percentage of your Gross Annual Turnover, the extent of work involving
i Intruder alarm systems %
ii Fire alarm, fire extinguishing or fire suppression systems %
iii Computer installations %
iv Industrial process control systems %
v Contracts involving solely testing inspection or certification of existing systems or
portable appliances %
Other than in respect of v above, do you engage in contracts to provide technical services or designs for a fee where you will not be undertaking installation work as part of the same contract?
YES NO
If “YES”, please provide details of the services provided and the fees charged:
8. Please estimate for the next twelve months the maximum number of persons engaged in the business and
the annual gross salaries and wages
Maximum Number Salaries/Wages
i Proprietors, partners and directors not working manually £ ii Non-Manual Employees £
iii Proprietors, partners and directors working manually £
iv Direct Employees working manually £
v Labour only subcontractors including agency labour £
9. Estimated payments to Bona fide subcontractors (independent supply & Fix
contractors) for the next twelve months £
10. Do you engage in:
i Contracts performed outside Great Britain, Northern Ireland, the Isle of Man or
the Channel Islands? YES NO
ii The export of goods or services to the United State of America or Canada? YES NO
iii The construction of, or any work in, airports, aircraft, watercraft, collieries, mines, gas, petrochemical and chemical works, railways, railway installations, power stations, oil refineries, fuel depots, quarries or offshore structures, or installations or at any other sites which may involve special hazards?
YES NO
iv Work on external aerials or masts or work at heights exceeding 15 metres or at
depths exceeding 3 metres? YES NO
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v The handling, storage or use of radioactive or other ionising substances, asbestos or silica or material containing silica, explosives, acids, chemicals or gases, or any other dangerous substance?
YES NO
vi Or do your subcontractors engage in the use of blow lamps, blow torches, electric oxy-acetylene or other burning, welding or cutting equipment, or any process involving the application of heat other than electrically powered soldering irons, away from your own premises?
YES NO
If “YES” to any part of Question 10, please provide full details
11. Do you own or operate lifts, cranes, hoists, boilers, steam containers or other
pressure vessels? YES NO
If “YES”, are these inspected to comply with statutory requirements? YES NO
12. Are your business premises in a good state of repair and your plant and
machinery properly fenced and guarded? YES NO
13. Do you check that subcontractors you engage are properly and adequately
insured prior to the commencement of the work they are to perform? YES NO
If “NO” to Question 11 ii, 12 or 13, please provide full details
14. Do, or could, any of your processes result in the escape or discharge into the
atmosphere or land of any toxic or dangerous substance? YES NO
15. Do you:
i Apply contract conditions that may extend your legal liability? YES NO
ii Accept or have you accepted onerous contract conditions requiring you to assume the liability of another party in respect of the negligent acts, errors or omissions of such other party?
YES NO
If “YES” to any part of Question 14 or 15, please provide full details
COVER REQUIRED
1. Please advise the date the Insurance is to commence:
Note: Cover will not commence until ECIC have accepted this Proposal or agreed to hold covered.
2. Please advise the Public/Product Liability indemnity limit you require:
Note: Limits of £1,000,000, £2,000,000 or £5,000,000 are available £
3. Do you require Employers’ Liability cover?
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4. Do you require Contractor’s all Risks or Tools insurance YES NO
If “YES”, please select level of cover required:
Contractors’ all Risks
Tools Insurance Only - Single Article Limit £1,000
5. In respect of Contracts you may undertake, what is the maximum:
i Contract Value (including the value of any Free-issue Materials and temporary
works that you may be responsible for) £ ii Contract Period including any maintenance or defects liability period
6. What is the
i Total current value of the plant, tools and equipment that belong to you £
ii Maximum current value of any one item in i above £
iii Total current value of site huts and other temporary site accommodation
(including their contents) that belong to you £ iv Maximum total value of plant, tools, equipment, site huts and temporary site
accommodation hired in by you at any one time £
7. In the course of your business do you ever hire out plant to other parties? YES NO
8. Do you require Personal Accident insurance YES NO
If “YES”, please select level of cover required:
Principals/Partners/Directors YES NO Number of units required per person
All other Employees
Note: Cover is not available for labour only subcontractors
YES NO
9. Are all persons to be insured in sound physical and mental health and free of
physical defect and infirmity YES NO
CLAIMS AND INSURANCE HISTORY
1. Have you or any partner or director (in connection with this or any other
business in which you or they have been trading):-
i Suffered any loss, made any claims or been involved in incidents which have or could have resulted in a claim in respect of the risks proposed within the last
5-years? YES NO
ii Had claims settled or notified against you within the last 10 years in respect of an occupational illness or disease (i.e. deafness, vibration white finger, repetitive strain injury, dermatitis, lung disease or cancer) or pollution or contamination?
YES NO
If “YES” to either i or ii above, please advise: Type of
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2. Please provide the following information about your present insurance. If you are not presently insured
(other than where your policy has recently lapsed) please state “none”.
Present Insurer Renewal Date
i Employers/Public Liability ii Contractors all Risks/Tools iii Personal Accident
3. Has an insurer ever
i declined to insure you? YES NO
ii cancelled or declined to renew any of your insurances? YES NO
iii required special terms? YES NO
4. Have you or any director or partner ever been
i convicted of or charged (but not yet tried) with any criminal offence other than
motor? YES NO
ii declared Bankrupt or insolvent? YES NO
iii a director or partner of a company that went into liquidation? YES NO
iv the subject of a recovery action by Customs and Excise or the Inland Revenue? YES NO
If “YES” to any part of Questions 3 or 4 above, please advise details:
DECLARATION
1. I/We declare that to the best of my/our knowledge and belief
i. the statements and particulars supplied by me/us or on my/our behalf in this proposal are true and
complete
ii. any statements or particulars supplied by me/us or on my/our behalf separately are true and complete
iii. that no material information has been withheld.
2. I/We agree that this proposal and any statement and particulars supplied separately shall form the basis of
the contract between me/us and the EC Insurance Company Limited.
3. I/We agree to accept the EC Insurance Company Limited’s usual form of policy for this type of insurance. A
specimen copy of the policy is available on request.
4. I/We understand that Insurers share information with each other, credit reference agencies and other
information agencies with regard to credit agreements, policies and claims, primarily to help assess risks, handle claims and prevent frauds. I/We consent to this.
Authorised Signature Date
Material Information
Material information is considered as facts, which if divulged to an insurer might be construed as influential to his/their acceptance of any risk. If you are unsure whether any fact could be construed as "Material Information" you should disclose it.
We recommend that you should keep a record of all information, including copies of this proposal form and any letters, supplied to us for the purposes of entering into this insurance contract.
UW/2015/03/02 03 Page 6 of 6
Data Protection Act
We may use the personal and business details you give us, or which are supplied by third parties, to provide you with a quotation, to administer your policy, to search the files of credit reference agencies who may keep a record of the search, to carry out such financial and other enquiries as we consider necessary to evaluate the risk and assist in making a decision regarding our acceptance of the risk, to support the development of our business including your details in customer surveys, and for market research and compliance business reviews. We may also share these details with other insurance
organisations to help off-set risks, to help administer your policy and to handle claims and prevent fraud. We will store your details on computer but will not keep them for longer than necessary. Under the terms of the Data Protection Act 1998, you are entitled to a copy of all the information we hold about you.
Notice to Proposers Under the Insurance Companies (Third Insurance Directives) Regulations 1994
If you are applying for insurance protection as a private individual or as a sole trader (or for the benefit of a private individual or sole trader) you should carefully read the following information.
Law Applicable to the Contract
The law applicable to this insurance contract is subject to agreement between the parties.
Unless a special endorsement to the contrary has been requested by you and agreed by us the law applying to this Insurance contract will be as follows:
a. if you are applying for insurance protection as a private individual the law applicable to that part of the United Kingdom, Channel Islands or Isle of Man in which you or the first named policyholder normally resides, or b. if you are applying for insurance protection in your capacity as a sole trader the law applicable to that part of the
United Kingdom, Channel Islands or Isle of Man in which you have your principal place of business, or c. if neither of the above applies, the Law of England and Wales.
EC Insurance Company Limited (Company No 1266206) Registered in England and Wales at ECA Court, 24-26 South Park, Sevenoaks, Kent TN13 1DU.
Customer Care
EC Insurance Company Limited ('ECIC') is committed to maintaining a high standard of professional conduct in all our dealings with customers.
However if you feel that your insurance arrangements have not been handled in the manner in which you would expect and you wish to make a complaint, please contact the Underwriting Manager at the office of ECIC that issued your policy. We will ensure that the matter receives immediate attention. You will be sent a copy of our Complaints Handling Procedure. If you feel that the matter has not been settled to your satisfaction you may write to the General Manager, ECIC, ECA Court, 24-26 South Park, Sevenoaks, Kent TN13 1DU.
If you are not satisfied with our investigation and conclusion of your complaint or eight weeks have passed since initially making your complaint and you are an individual consumer or a business with a group annual turnover of less than £1million you may refer the matter to the Financial Ombudsman Service, South Quay Plaza, 183 Marsh Wall, London E14 9SR.
ECIC is a member of the Association of British Insurers and a member of the General Insurance Standards Council. ECIC is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.
Your right as a policyholder to take legal action remains unaffected by the existence of the complaints procedures referred to above.
