Business Details
Full name of Proposer including all trading names, group companies and subsidiaries that are to be covered by the policy
Please list names and dates of birth of all Directors/Partners
If you require Employers’ Liability cover, please supply your Employer PAYE Reference(s). (This information is required for us to provide Employers’ Liability cover. Where you have more than one PAYE Reference, please advise each one making it clear which company they apply to)
If you do not have a PAYE Reference, please confirm that you are exempt and give the reason.
Postal Address (including Postcode)
Risk Address (if different from above)
Contact Name
Telephone Number
Fax Number
E-Mail Address
Website Address
Full Business Description (including details of activities away from the premises)
How long have you been in business at these premises?
How long have you been in business elsewhere?
Are the buildings occupied solely by you?
Yes  No
If not, please give details of other occupant's trades and the proportion of the building they occupy:
Please list any Trade Association you belong to:
   
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