Tradesman Liability Risk Questionnaire Gas Engineers 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 Self Employed Partnership Limited Company 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 £2M £5M 1.2 Do you require cover for oxyacetylene welding, cutting or other welding equipment?   Yes No 1.3 Policy Excess £250 £500 £1000 1.4 Type of premises covered Class 1 Class 2 Class 3 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 £1000 £2000 £4000 3.3 Tool cover Excess £50 £100 £150 4. Stock in Transit  Yes No 4.1 Stock in transit cover £1000 £2000 £3000 £4000 4.2 Stock in transit Excess £50 £100 £150 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       £500 £1000 £2000 £2500 6. Group Personal Accident Cover  Yes No Number of people: Employee type Units A Units B 6.1 Proprietor/Directors None 1 2 3 4 None 1 2 3 4 6.2 Clerical employees None 1 2 3 4 None 1 2 3 4 6.3 Manual employees None 1 2 3 4 None 1 2 3 4 7. Insurance History 7.1 Current premium (£) 7.2 When does your existing policy expire? Or from when is cover required? 7.3 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. In doing so, you voluntarily choose to provide personal details to us via this website. Personal information will be treated as confidential by us and held in accordance with the Data Protection Act 1998. You agree that such personal information may be used to provide you with details of services and products in writing, by email or by telephone. If you prefer to fax the form to us, click the printer icon below: and fax to us on 0121 447 7556 Courtprice Limited is Authorised and regulated by the Financial Services Authority.