1. Full Name of the Insured (including the name of all subsidiary companies):
2. Full Business Description:
3. Business Address & Postcodes (if more than one location please state all premises – on an additional schedule if necessary):
4. How long has the business been established ?_________________________________________ 5. Date from which cover is required ? _________________________________________________ 6. Has any Insurer:
• Refused to accept a proposal from you? YES □ NO □
• Refused to continue a Policy of Insurance held by you? YES □ NO □ • Imposed special terms on an Insurance Policy held by you? YES □ NO □ 7. Have you or any of your businesses ever been declared bankrupt, insolvent or gone into liquidation? 8. Have any actions of bankruptcy been made against you?
YES □ NO □ If “YES” please supply full details.
9. Have you, or any of your business partners or directors ever been convicted of or charged with a criminal offence, other than a motoring offence?
YES □ NO □ If “YES” please provide full details.
10. Has your Contractors All Risk, Plant & Machinery policy been claim free for the past 3 years? YES □ NO □ If NO – Please provide details below :-
Contractors All Risks
Please confirm the following
(i) The total estimated annual contracting turnover of The Business (including the total estimated annual value of any free issue materials) (ii) The maximum estimated value in respect of any one contract (iii) The average estimated value in respect of any one contract
(iv) The maximum estimated contract period in respect of any one contract (v) The average estimated contract period in respect of any one contract (vi) The total value of all employees tools to be insured
(vii) Details of the typical types of contract undertaken
£
£ £months months £
Contractors Plant / Equipment
Please answer the following
1. The Contractors Plant & Equipment to be insured is used solely in connection
with the Business Yes / No
2. The Contractors Plant & Equipment is used only within Great Britain, Northern Ireland,
The Isle of Man and The Channel Islands? Yes / No
3. The Contractors Plant & Equipment is operated, maintained and serviced in
accordance with the manufacturers recommendations Yes / No
4. The Contractors Plant & Equipment is returned to a lockfast building or secure
compound when not in use Yes / No
5. The Contractors Plant & Equipment is inspected in accordance with any
statutory regulations Yes / No
6. The Contractors Plant & Equipment is used by operators licensed in
accordance with statutory regulations Yes / No
7. The Contractors Plant & Equipment is not used in hazardous conditions?
e.g. demolition, mining, dynamiting, underground, on or near water, on bridges etc Yes / No 8. The Contractors Plant & Equipment is not used in hazardous conditions?
e.g. demolition, mining, dynamiting, underground, on or near water, on bridges etc Yes / No 9. The Contractors Plant & Equipment is not hired out under conditions less onerous
than the model conditions of hire approved by the Contractors Plant-hire
Association (CPA) or the Scottish Plant Owners Association (SPOA) Yes / No 10. Is cover required during loading transit and unloading ? Yes / No 11. Is cover required whilst plant is let out on hire or loan to any third party ? Yes / No If answer is YES – is indemnity to the first hirer required Yes / No 12. Does any of the Contractors Plant & Equipment take in and process materials
and/or feedstock ? Yes / No
Please confirm the following
(i) The total new replacement value of Contractors Plant & Equipment owned by the Business
(ii) The total market value of Contractors Plant & Equipment owned by the Business
(iii) Maximum any one accident limit for owned plant per (1) or (2) above (iv) The maximum value of Contractors Plant & Equipment hired in by the Business at any one time
(v) The annual hiring charges incurred by the Business (vi) The annual hiring charges received by the Business
Please attach a full schedule of plant including item description, age, market value and new replacement value – or provide in the box below
Declaration
I declare that I am authorised to complete this proposal on behalf of the Business and that, to the best of my knowledge and belief, the statements and particulars in this proposal are true and correct and no material facts have been
suppressed or mis-stated. I undertake to inform Insurers of any change to any material fact which occurs before any insurance based on this proposal is effected and acknowledge that this proposal, together with any other information supplied to Insurers, shall be the basis of such contract.
Signed:__________________________________ Name:_______________________________ Position:_________________________________ Date:________________________________
