If yes please provide the following information
- Details of the work subcontracted and estimated payments for the next 12 months
If yes please provide details
If yes please provide details
If yes please provide details
CLAIMS AND RELATED DETAILS
Have any incidents occured during the last 5 years resulting in injury (including death, disease or illness) to members of the public or damage to their property arising out of:-
If yes please provide details
Public Liability:
Products Liability:
IMPORTANT
The questions on this form and any other details the Company may request in connection with the Proposal for insurance relate to facts which the Company considers material to underwriting this insurance, however because no list of questions can be exhaustive please consider if there is any other material information relevant to this proposal, which could influence the company assessment and acceptance of the insurance, and advise the company accordingly. Failure to disclose all material facts whether or not the subject of a specific question may invalidate the insurance.
DECLARATION
I/We warrant that the above statements made by me/us or on my/our behalf are true and complete and i/we agree that this proposal shall be the basis of the contract between me/us and the Company. I/We agree to accept a policy in the company's usual form for this class of insurance.
NOTE: Signing this form does not oblige you to complete the insurance.)