fields marked with * are required
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Proposer Details |
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Trading As * |
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Mobile |
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Email |
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Fax * |
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Contact Address & Post Code * |
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Type of Company
(Sole Proprietor / Partnership / Ltd) |
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Date of Cover required |
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Amount of Liability Cover Required (£m) |
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Employers |
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Public |
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Type of Business
(Describe type of work, ie building, roofers, etc)
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Nos Years Experience in Trade
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Nos Principals/ Partners/Directors
engaged in |
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Manual |
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Clerical |
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Nos Employees
(Labour only, sub-contractors, under government schemes) |
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Full Time |
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Part Time |
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Proportion of Time Spent on Dangerous Activities ( % ) |
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Blow Lamps % |
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Slings and Cradles % |
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Woodwork % |
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Yes
No
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Please provide details of any claims and convictions |
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