Regus Sterling business insurance
Regus Sterling
Commercial insurance
Group Insurance
Public Liability
Employers Liability
Product Liability
Professional Indemnity
Directors and Officers Liability
Contract All Risks
Fleet
Business Interuption
Commercial Legal
CHAS Insurance
Testimonials
Contact Us
Insurance Quote
Step 1 of 6
16%
Commercial Combined
Contact Name
*
First
Last
Business name
*
Contact Phone
*
Email
*
Business Type
*
i.e. Ltd, PLC, Sole Trader, Partnership
Business Address
*
Street Address
City
Zip / Postal Code
What type of work is undertaken (e.g. Plumbing 25% Heating 25% Building Maintenance 50%
*
Work
%
Click + to add more rows if needed
What type of premises do you work on
COMMERCIAL %
DOMESTIC %
INDUSTRIAL %
OTHER % **
** Please list details in space provided below
Type of premises not listed above:
Date business commenced trading
*
Renewal Date
*
List
*
Current Insurer
Last Years Premium £
Are you a member of a relevant trade association?
*
Yes
No
If YES please give details below
Trade Association Membership
If you clicked YES above please give details here
Business Details and activities
Claims
Date
Circumstances
Cost £
Please detail any claim made against you in the last 5 years
Hazardous activities
Use of acids, gases or chemicals
*
Yes
No
Wood working machinery?
*
Yes
No
Use of heat
*
Yes
No
i.e. heat gun, welding, propane torch
What is the Maximum Height you work at?
*
What is the Maximum Depth you work at?
*
Do you work at Airports / Railways / Power Stations / Farms or Hospitals?
*
Yes
No
If you have answered 'yes' to any of the above activities provide full details below with a % split of how this work contributes to your turnover...
Details of work at Airports / Railways / Power Stations / Farms or Hospitals:
Bonafide Sub Contractors 'BFSC'
Do you use BFSC?
*
Yes
No
Do you ensure they have the same level of public liability as yourselves
Yes
No
If BFSC are used, what are they employed to do.
Please provide % split of activities.
Health & Safety
Is there a health & safety policy statement tailored to your activities?
*
Yes
No
Is there a specifically trained director / employee responsible for Health & Safety?
*
Yes
No
Is health & safety training given to all staff throughout their employment?
*
Yes
No
Workplace Inspections
Is all equipment that needs statutory inspection identified and routinely inspected?
*
Yes
No
COVER REQUIRED - LIABILITY
Public & Products Liability - Section must be completed for all risks
Indemnity limit required
*
Specify: £1,000,000 / £2,000,000 / £5,000,000 / £10, 000,000
Employers Liability
Indemnity limit required
*
Pleas put N/A if not applicable)
PAYE: reference for any policy with EL cover
Estimated Wageroll Payments for the Forthcoming Year
Directors - Manual
Number
Wage Roll £
Directors - Clerical
Number
Wage Roll £
Clerical Employees
Number
Wage Roll £
Manual Employees (on - site)
Number
Wage Roll £
Manual work away employees
Number
Wage Roll £
Column 3
Subcontractors (Labour only)
Number
Wage Roll £
Bona-fide Subcontractors
Number
Wage Roll £
TOTAL TURNOVER INLUDING EXPORT
*
Estimated for period of insurance
EXPORT WITHIN THE EU
GIVE TURNOVER AND COUNTRIES
EXPORT TGO THE USA OR CANADA
GIVE TURNOVER AND COUNTRY
Buildings Insurance
Please complete this section if you require Buildings or Contents cover.
Buildings Sum Insured
Full reinstatement cost
Please advise the construction of the WALLS
Please advise the construction of the ROOF.
If flat roof state % or roof area.
Please Please advise the construction of the FLOORS and STAIRS.
Year of build
Is there a full functional security alarm at the premises.
Yes
No
PLEASE SPECIFY BELOW if NACOSS / Bells only / Central Station / RedCare and any OTHER SECURITY SUCH AS CCTV / 24 HRS GUARDING
Are all ground floor WINDOWS & accessible 1st Floor Windows fitted with any of the following - key operated locks / Bars / Grilles or Shutters - PLEASE SPECIFY
Are all external doors fitted with any of the following - Sheet Metal / Bars / Grilles or Shutters / 5 Leaver Mortise Dead Locks - PLEASE SPECIFY
Is there a fully functional fire alarm at the premises?
Yes
No
If YES is it linked to the intruder alarm?
Yes
No
Are there smoke / heat detectors throughout the premises?
Yes
No
Fire extinguishing appliances - as per fire officers requirements?
Yes
No
Low pressure hot water - Central Heating
Yes
No
Portable Oil / Gas / Electric Heaters?
Yes
No
Accidental Dammage
Yes
No
Terrorism
Yes
No
Subsidence
Yes
No
Computers / Electronic Equipment
Fixtures & Fittings
Contents
Plant & Machinery
Stock
Goods In Transit
NON FERROUS METALS
COVER REQUIRED - BUSINESS INTERUPTION
Do you require cover for business interuption if so please complete this section.
Yes
No
SUM INSURED
£
Indemnity Period (12/24/36 mths)
COVER REQUIRED - CONTRACTORS ALL RISKS 'CAR'
Temporary Buildings
Replacement value of Own Plant
Single item limit
Contract Works Cover Linit Any One Contract
Employees tools
Limit per employee
Hired In Plant
Maximum Value any one item
Annual Hiring Charges
Type of plant hired in:-
Declaration of Material Facts
Has the Company or any Director or partner ever:-
had any prosecution/prohibition notice or improvement order issued during the last 5 years?
Yes
No
had any notice or order placed on the company under health and safety legislation in the past 5 years?
Yes
No
been convicted or charged but not yet tried with any criminal offence other than motoring offences?
Yes
No
been refused insurance or had special terms applied?
Yes
No
Any director or principal ever been declared bankrupt?
Yes
No
OTHER INSURANCES
DO YOU CURRENTLY HAVE ANY OF THE FOLLOWING POLICIES:-
FLEET
Yes
No
If YES please enter Renewal Date below
RENEWAL DATE (Fleet)
PROFESSIONAL INDEMNITY
Yes
No
If YES please enter Renewal Date below
RENEWAL DATE (PI)
OTHER
Yes
No
If YES please enter Renewal Date below
RENEWAL DATE (Other Policies)
