Courtprice Ltd can offer WIAPS members insurance cover with some of the world's largest insurance companies for less money than you are paying at present.

An exclusive opportunity for WIAPS members to find out if they can save money on their business insurance covering public liability insurance and other risks such as tools, stock, loss of income, accident and illness cover, ‘plus van and car’ insurances. There is no obligation - you can ask for a quote if you wish. It's just a great chance for you to protect your business and save money.

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:

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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 (inc postcode)
Telephone no.		Mobile no.
Fax no.
WIAPS Membership Number:

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. 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: and fax to us on 0121 447 7556 Courtprice Limited is Authorised and regulated by the Financial Services Authority.