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Contractors Combined Insurance  

 

 

 

 

 

 

 

 

 

 

Tradesman Liability Risk Questionnaire
IPHE Contractors Cover

Please fill out the form below and click on the 'Submit' button.
The information you provide will form the basis for a proposal form and cover issue.
Where needed help can be obtained dynamically by hovering your mouse over the help icon:
Header Assistance 
Or you may contact Courtprice Ltd on 0121 447 7555.


General Information:
ALL fields must be completed in this section
Surname   First Name  
Date of birth   Email address  
Contact address
Postcode    
Telephone no.   Mobile no.  
Fax no.    


Business Information
Company / trading name    
Company status
Business description    
Trade affiliations    
Number of years trading    
Business address
(if different from contact address - please include postcode)
Proposers / partners details:-
(not required for a Limited company)
 1. 
 2. 
 3. 
 4. 
Estimated turnover for next 12 months £  
Number of Manual Proprietor/Directors Number of clerical Proprietor/Directors
Number of PAYE employees Number of apprentices
Number of LOSC Number of clerical employees
Number of BFSC  


1. Public Liability Cover (compulsory section)
1.1 Limit of indemnity
1.2 Do you require cover for oxyacetylene welding, cutting or other welding equipment?   Yes No
1.3 Policy Excess
1.4 Type of premises covered

2. Employers Liability Cover 
Limit of indemnity £10,000,000 including costs and expenses
2.1 Specify additional premises
2.2 Do you require temporary manual employee cover?   Yes No
2.3 Injury to working partners required?   Yes No
2.4 Cover for work experience?   Yes No
2.5 Limited liability company?   Yes No
2.6 Estimated wages for clerical employees £
2.7 Estimated wages for manual employees £
2.8 Estimated wages for LOSC £
2.9 Estimated wages to all employees £


3. Tools  Yes No
3.1 No. of Manual workers
3.2 Sum insured per person
3.3 Tool cover Excess


4. Stock in Transit  Yes No
4.1 Stock in transit cover
4.2 Stock in transit Excess

5. Contract Works  Yes No
Type of cover Sum insured
5.1 Contract Limit  £ 
5.2 Plant Equipment and tools  £ 
5.3 Temporary Buildings  £ 
5.4 Hired in machinery and plant  £ 
5.5 Contract works Excess      


6. Group Personal Accident Cover  Yes No
Number of people: Employee type Units A Units B
6.1 Proprietor/Directors
6.2 Clerical employees
6.3 Manual employees


7. Jury Service  Yes No
Employee type Number of people:
7.1 Proprietor/Directors at £250 per week
7.2 Employees at £150 per week


8. Insurance History
8.1 Current premium (£)
8.2 When does your existing policy expire? Or from when is cover required?
8.3 Have you had any claims in last 5 years? If yes please give details below. Yes No
Date: Details Amount (£)


Click on the submit button to send this form elecronically to Courtprice Limited.
If you prefer to fax the form to us, click the printer icon below:
Print
and fax to us on 0121 447 7556

Courtprice Limited is Authorised and regulated by the Financial Services Authority.