Electricians Liability Insurance Quote Form

Please insert your details below and one of our commercial advisers will contact you shortly with a liability insurance quotation.

This form is designed for quotes for Public/Employers Liability Insurance for electricians/electrical contractors only.

If you have any problems with completing this form, please phone us on 01623 641 386 for assistance.

Personal/Company Details
Proposer's Full Name(s): (enter sole trader's name or all partner's names if a partnership)
Contact Name: (if different to proposer's name)
Limited Company Name: (if operating as a limited company)
Trading Name / Trading As: (if different to the above)
Trading Status:	- - - - - - - - - Please Select - - - - - - - - Sole Trader Partnership Limited Company (Ltd) Limited Liability Partnership (LLP) Unincorporated Association
Business Address:
Postcode:
Daytime Telephone Number:
Mobile Telephone Number:
*E-Mail Address:
*Please note that your email address will only be used to provide you with your quote and not for any other marketing purposes.
General Information
Proposer's Details
Have you, or any other partner or director ever been convicted of or charged (but not yet tried) with any criminal offences other than a motoring offence?	Yes     No
If yes, please provide details: (e.g. type of conviction(s), date(s) of conviction(s), details of any fines and/or length of custodial sentence(s))
Has any insurer ever refused renewal, declined/cancelled cover or imposed any special terms?	Yes     No
If yes, please provide details: (e.g. reason for insurance refused/cancelled/special terms imposed, date of refusal/cancellation/special terms imposed, etc.)
Have you, or any other partner or director ever had any County Court Judgements (CCJ's) / sheriff decrees / IVA's or ever been declared bankrupt, or involved in a company which has become insolvent or which has gone into liquidation, receivership or administration?	Yes     No
If yes, please provide details: (e.g. date(s) of bankruptcy/insolvency/CCJ/IVA, amount of bankruptcy/insolvency/CCJ/IVA (£'s), date bankruptcy discharged / date CCJ/IVA settled, circumstances of bankruptcy/insolvency/CCJ/IVA, etc.)	Please note we are unable to provide a quote if your bankruptcy is not discharged or your CCJ / IVA remains outstanding or unsettled.
Have you, or any other partner or director ever been prosecuted or served a prohibition order by the Health & Safety Executive?	Yes     No
If yes, please provide details: (e.g. date of prosecution(s)/prohibition order, details of offence(s)/prohibition order, etc.)
Have you, or any other partner or director ever been the subject of a recovery action from HM Customs and Excise or the Inland Revenue?	Yes     No
If yes, please provide details: (i.e. name of person or business subject to recovery action, date of recovery action, and reason for the recovery action)
Business Activities
Description of your work activities: (Please describe as fully as possible including a percentage split between each activity, if you carry out more than one activity.)
3 Phase Electrical Work
Do you carry out any 3 phase work?	Yes     No
Trade Questions
Does your work include any aerial erection?	Yes     No
Does your work include work with alarms? (i.e. installation/maintenance,etc.)	Yes     No
Does your work include work in or on motor vehicles?	Yes     No
Efficacy Cover
Is Efficacy cover required? (cover for failure of a product to perform its function (e.g. alarms, etc.))	Yes     No
Type of Premises / Locations Worked at (away from your own premises)
What percentage of your work is carried out at the following locations away from your own premises:
(i) Private Dwelling Houses and Flats?	%
(ii) Commercial Buildings (e.g. shops, offices, pubs, etc.)?	%
(iii) Industrial Buildings (e.g. industrial units, factories, etc.)?	%
(iv) Other Premises (specify below if applicable) ?	%
Total:	100%
Is your home the base for your business or are you operating from separate dedicated business premises?	Home  Business Premises
Is work carried out at any hazardous locations? These can include, but are not limited to; railways, motorways, bridges, viaducts, nuclear installations, refineries, airports, quarries, mines, ships, docks, piers, towers and offshore installations.	Yes     No
If yes, please state type of location(s) and the percentage of work spent at the location(s):
Is any work undertaken outside of the U.K.?	Yes     No
If yes, please provide details: (i.e. area / country work is carried out at, and percentage of work outside UK)
Professional Risks
Do you provide professional services for a fee such as advice/consultancy, design, testing, inspection and certification?	Yes     No
Height Work
Please confirm the maximum height you would work?	0 5 10 15 20 25 30 35 40 45 50+ metres
If any work is above 15 metres, please provide details: (e.g. type(s) of contract(s)/work undertaken, and percentage of turnover that this work represents)
Heat Use
Do your activities involve the use of heat? (e.g. blow lamps, blow torches, welding equipment, heat guns, etc.)	Yes     No
If yes, please state the type of heat used: (e.g. blow lamps, blow torches, welding equipment, heat guns, etc.)
Please confirm the percentage of time it is used:	0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%
Will heat work include the use of welding or flame cutting equipment?	Yes     No
Years Trading / Experience
How many years has your business been trading?	Please Select 0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years 21 Years 22 Years 23 Years 24 Years 25 Years 26 Years 27 Years 28 Years 29 Years 30 Years 31 Years 32 Years 33 Years 34 Years 35 Years 36 Years 37 Years 38 Years 39 Years 40 Years 40+ Years
Number of years experience (if greater):	Please Select 0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years 21 Years 22 Years 23 Years 24 Years 25 Years 26 Years 27 Years 28 Years 29 Years 30 Years 31 Years 32 Years 33 Years 34 Years 35 Years 36 Years 37 Years 38 Years 39 Years 40 Years 40+ Years
Claims History
Have you, or any other partner or director suffered any loss or had any claims made against you in the last 5 years?	Yes     No
If yes, please provide details:	Date of claim: Cost of claim:£ Details of claim: ---------------------------- Date of claim: Cost of claim:£ Details of claim: ---------------------------- Regrettably, if you have more than 2 claims, we will be unable to provide you with a quotation.

Details Of Liability Cover Required
Public/Product Liability
Public/Product Liability limit of indemnity:		£1 Million £2 Million £5 Million £10 Million Not Required
Number of Proprietors/Partners/Co. Directors:	No.
Wages of Proprietors/Partners/Co. Directors:
Please state your annual payments to Bona-Fide Sub-Contractors (if used): (BFSC's are sub-contractors who supply their own materials on site, work without your supervision, and hold their own liability insurance)
Turnover
Estimated Annual Turnover for next 12 months:
Employers' Liability (Compulsory by Law if you have employees or use labour only sub-contractors)
Is Employers' Liability Cover Required? (£10M standard limit of indemnity)		Please Select Yes No
Number of Clerical/Administrative Employees: (Do not include proprietors, partners or directors)	No.
Total Annual Wages of Clerical Employees:
Number of Manual Working Employees: (Do not include proprietors, partners or directors)	No.
Total Annual Wages of Manual Employees:
Employers' Reference Number (optional)
Employers' Reference Number (ERN) (if available):		(e.g. 123/AB12345 or 'Exempt')
Optional Covers / Additional Information
Tools Cover (optional)
Is Tools cover required?		Yes     No
Tools Sum Insured:		£1,000 £1,500 £2,000 £2,500 £3,000 £4,000 £5,000
Professional Indemnity (optional)
Is Professional Indemnity cover required? (Recommended if you provide advice, design, specification, testing, inspection or certification)		Yes     No
Limit of indemnity required:		£50,000 £100,000 £250,000 £500,000 £1,000,000 £2,000,000 £5,000,000
Does more than 25% of your turnover relate to pure design, surveying, training or consultation carried out for a fee?		Yes     No
Business Legal Expenses Cover (optional)
Is Business Legal Expenses cover required? (£100,000 cover for legal disputes, employment disputes, tax investigations, etc.)		Yes     No
Legal Expenses Limit of Indemnity:
Has the business been involved in any legal disputes, employment disputes, or tax investigations in the last 5 years?		Yes     No
If yes, please provide details:
Directors & Officers Cover
Do you require Directors & Officers Cover?		Yes     No
Can you confirm that the company is domiciled in the UK; is privately held; has not raised any funds from external parties; has been in operation for more than 12 months; has its financial statements prepared by a qualified accountant, shows a profit and are not subject to any concerns by the auditors; derives at least 50% of all its turnover from clients within the UK and EU; has not acquired any companies which have increased its total assets by 50% or more; and has no mergers or acquisitions planned and has not had any claims made against it or its directors and is not aware of any circumstances that could give rise to such claim?		Yes     No
If no, details:
Limit of indemnity required?:		£100,000 £250,000 £500,000 £1,000,000 £2,000,000 £5,000,000
Additional Information
Details of any additional information that you wish to disclose or any other cover required:
You are required to make a fair presentation of the risk to insurers which means that you are required to disclose every material circumstance which you know or ought to know relating to the risk to be insured. Materially important information is any information that could influence an insurer's decision to accept your risk including the cost of your insurance. Failure to comply with the duty of fair presentation could mean that your policy is void or that insurers are not liable to pay all or part of your claim(s). By submitting this quotation you are confirming that there are no other material facts to disclose other than those shown above.
Details Of Current / Previous Policies
Cover Start Date / Renewal Date:		(dd/mm/yyyy)
Current Annual Premium / Best Quotation:		This may help us to get you a better quote
Name of Current / Previous Insurer:		e.g. Aviva, AXA, Allianz, QBE, RSA, Zurich, etc.

Request Quotation

Disclosure
Please ensure that all the information you have provided is correct and that you have answered all the questions accurately then press the Request Electricians Liability Quotation button and we will contact you shortly with a quotation.

Estimated Quote Time: 1 to 72 hours