Public Liability Insurance proposal form

Do you ensure that the sub-contractors have adaquate liability insurances in force with an indemnity limit at least as high as the which you are arranging and do you ensure that such insurances are maintained in force?

YesNo

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:-

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.

Public Liability Insurance Proposal