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Care / Nursing Home Insurance Quotation Form

For UK Customers Only

Please insert your details here and one of our commercial insurance business advisers will contact you shortly.

This form is designed for quotes for single location Residential Care / Nursing Home Insurance.

If you require a quotation for multi-location care home insurance or have any problems with completing this form, please phone us on 01623 641 386 for assistance.

Contact/Company Details

Proposers Full Name(s):
(enter sole trader's name or all partner's names if a partnership)
Contact Name:
(if different to proposer's name)
Ltd. Company Name:
(if operating as a limited company)
Trading Status:
Care Home Trading Name:
Care Home Address:
Care Home Postcode:
Daytime Telephone No.
Mobile Telephone No.
E-Mail Address:
 
General Information

Please state the number of years you
have been trading at these premises:
years
Please state the number of years you
have been trading elsewhere (if applicable):
years
Is the business registered with
the appropriate regulatory body?
(i.e. Care Quality Commission (England), Care and Social Services Inspectorate
Wales, or Scottish Commission for the Regulation of Care)
No     Yes
If you have purchased an existing care
home within the last 12 months, do you intend
to predominantly continue with the existing staff?
No     Yes
If no, please provide details of the changes:
Proposers History
Have you, or any other partner or director ever been
convicted of any offences or had any insurance
refused, cancelled or special terms imposed?
No     Yes
If yes, please provide details:
(e.g. type of conviction, date(s) of conviction,
details of any fines, custodial sentence, or
details of any insurance refused/cancelled, etc.)
Have you, or any other partner or director ever been
declared bankrupt or the subject of bankruptcy proceedings, liquidation, insolvency, appointment of administrative receiver or administrators or made any arrangement with creditors either in a personal capacity or in connection with any business with which anyone has been involved?
No     Yes
If yes, please provide details:
(e.g. date(s) of bankruptcy/insolvency,
amount of bankruptcy/insolvency, date
discharged, circumstances, etc.)
Have you, or any other partner or director ever had any County Court Judgements/Sheriff Decrees made against them in a personal capacity or against any business in which any of them have been involved?No     Yes
If yes, please provide details:
(e.g. date(s) of CCJ, amount of CCJ,
is the CCJ still outstanding,
circumstances, etc.)
Have you, or any other partner or director
ever been prosecuted or served a prohibition
order under the Health & Safety at Work Act, the Factories Act or any similar legislation?
No     Yes
If yes, please provide details:
(e.g. date of prosecution(s),
details of offence(s), etc.)
Details of Care Home
Is the home currently occupied?No     Yes
Is the property currently trading as a care home?No     Yes
About the Business
What care does the business provide at or from this location?
(Please tick all that apply)
Care home providing personal care Care home providing nursing care
Adult placement schemes Hospice
Domicilliary care - personal care only Domicilliary care - with nursing
Supported living - personal care only Supported Living - with nursing
Day Centre  
Details of Residents
Please state the minimum age of residents:
Please state the maximum number of
residents that the home can accommodate:
Number of residents currently in the home:
Details of Residents / Service User Type(s)
What categories of service user is the business registered to care for?
(Please tick all that apply)
Elderly Children
Dementia Mental Disorder (ex. Learning Disbaility / Dementia)
Learning Disability Physical Disability
Past or Present Drug Dependence Past or Present Alcohol Dependence
Sensory Impairment Terminally Ill
Over 65, but not category of old age Old age not falling within another category
Other (please provide details opposite)
Mental Illnesses
Does the home provide residential
accommodation for any persons detained under
the provisions of the Mental Health Act 1983?
No     Yes
If yes, give details including
numbers, ages & cause of detention:
In respect of homes caring for residents with mental health problems or learning disabilities:
(i) Explain the nature and severity
of the illnesses/disabilities catered for:
(ii) Does the home accept clients with a history
of violence, aggression, sexual offences or arson?
No     Yes
If yes, please provide details of how they are
managed in order to protect other persons from injury:
Have there been any incidents
of assault or abuse over the last 5 years?
No     Yes
If yes, please provide details:
Additional Risk Information
Does the home offer any
surgery post operative care?
No     Yes
If yes, please state the percentage:%
Please list arrangements for any services
made available to residents in the care home:
(e.g. physiotherapy, etc.)
Are any of the above services
provided by you or your employees?
No     Yes
If yes, please provide details:
If no, do you ensure that the practitioner holds Public Liability and/or Professional Indemnity Insurance?No     Yes
Do you provide any recreational facilities?
(e.g. swimming pools, jacuzzis, gymnasiums, etc.)
No     Yes
If yes to the above, please give details:
Are the residents/patients
needs assessed and documented?
No     Yes
Do any of the residents suffer
from alcoholism or drug addiction?
No     Yes
If yes, please provide details:
(i.e. No. of residents, type of addiction, etc.)
Are staff in attendance 24 hours a day?No     Yes
Claims Experience
Have you or any previous owner, director or
partner of the business suffered any loss,
damage, injury or liability in the last 5 years at
these or any other premises whether insured or not?
No     Yes
If yes, please provide details i.e. date of claim,
description of claim, amount claimed, etc.:
Health & Safety
Does the home have a written Health and Safety
policy and are details of that policy passed to all employees?
No     Yes
Does the home comply with Health and Safety,
COSHH and other environmental/health regulations?
No     Yes
Does the home have a specific action plan with regard to the clearing up of spillages of liquids and water, especially in the kitchen and bathroom environments, and warning notices to cordon off areas that are damp or wet be available and used?No     Yes
Are regulators fitted to restrict the temperature
of hot water and radiator surfaces/pipes
to a maximum of 43 degrees centigrade?
No     Yes
Is a pre-employment health questionnaire completed by all prospective employees and, in particular, specific enquiries about back problems made?No     Yes
Are all staff properly trained in lifting techniques
and is the training recorded in writing and
does each member of staff sign a statement
to confirm that they have received such training?
No     Yes
Building Construction
Construction of the walls (e.g. brick, stone, etc.)
Construction of the roof (e.g. tile, slate, etc.)
(If flat, state if 'felt/bitumen' or 'concrete')
Is there any flat roofing on the property?Yes     No
Percentage of flat roof (if applicable)%
Type of flat roof (e.g. felt on timber, concrete, etc.):
Is the area of flat roof in good condition and
checked annually for any signs of deterioration?
Yes     No
Construction of floors (e.g. concrete, wood, etc.)
Approximately, what year was the property built?
Is the building purpose built or converted?Purpose Built  Converted
Is the property a grade listed building?
(e.g. grade I, II, II* etc.)
Has any part of the property ever been
affected by any subsidence or flood damage?
No     Yes
If yes, please provide details:
(e.g. type of damage, date of
damage, amount of damage, etc.)
How far away is the property from
the nearest watercourse, river, canal, sea, etc.?
Fire Protection
Is a fire alarm installed?No     Yes
If yes, please state type of fire alarm signalling:
 
Property Cover

Level of Cover Required? Help?
(Excluding Terrorism Cover)
Do you wish to include terrorism cover?No     Yes
Buildings
Buildings Sum Insured (including rebuilding,
architects' fees, removal of debris, etc.)
:
£
Conservatory(s) Sum Insured (if applicable):£
(Excluded unless stated above)
Do you wish to include cover
for subsidence, heave and/or landslip?
No     Yes
Stock
Deterioration of Frozen Food Sum Insured:£
Contents
Electronic Office Equipment Sum Insured:£
Care Home Contents Sum Insured:£
Residents Effects:
(500, 750 or 1,000 per resident):
£ per resident
Money
Money Sum Insured
(during business hours / in transit):
£
Money Sum Insured (in a locked safe):£
Employee Dishonesty
Is employee dishonesty cover required?Yes     No
Goods In Transit
Is goods in transit cover required?Yes     No
Goods In Transit Sum Insured:£

Business Interruption

Is business interruption cover required?
(i.e. cover for loss of revenue following an interruption)
No     Yes
Please confirm the
Annual Gross Revenue of your business:
£
Please state the period of
time you wish the cover to extend?
12 months
24 months
36 months
(allow sufficient time for
rebuilding/refurbishing and
time to resume normal trading)
Is cover required for
Loss of Registration Certificate?
No     Yes
If yes, please state sum insured required:£

Liability Cover

Public Liability:     Yes     No Indemnity Required?      help
Treatment/Malpractice Liability:     Yes     No Indemnity Required?     
Employers' Liability limit of indemnity:
(£10 Million automatically included)
 Help?
Please state the total number of employee's:
Please state the total annual wageroll (£'s):
(Do not include any Domiciliary Care)
Number of qualified nurses (e.g. RGN, SEN, RMN, etc.):
Number of auxiliaries:
Number of clerical / adminstrative employees:
Does the business provide Domiciliary Care?No     Yes
Please advise the type of domiciliary work carried out?
(e.g. 'meals on wheels', bathing, feeding, adminstering of drugs, etc.)
Please provide details of the number of
staff and the wageroll involved in domiciliary work:
Employers' Reference Number (ERN) (if available): help?
Turnover
Estimated turnover for the next 12 months (£'s):

Legal Cover / Directors & Officers Insurance

Is Legal Expenses cover required?No     Yes
If yes, limit of indemnity required?
Has the business been involved in any legal
dispute, tax investigation, or other court
or tribunal action during the last 5 years?
No     Yes
If yes, please provide details:
Is Directors & Officers insurance cover required?No     Yes
If yes, please state the limit of indemnity required:

Other Information/Covers

If there is any other information that you wish to
disclose or covers that you required, please provide details:
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

Current annual premium:
This may help us to get you a better quote
Current insurance provider:
Renewal date/date cover required:

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 Care Home Quotation button to send your quotation details to us.


Estimated Quote Time: 1 - 4 working days