Tradesman Package
Risk Questionnaire
Prepared on behalf of
Momentum
Press House
Narborough Wood Park
Desford Road
Enderby
LE19 4XT
Phone: 0116 238 8880
Your Contact:
10/10/2018 / Tradesman Package Risk Questionnaire / 1Contents
Client Details and General Information
Period of Insurance
Scope of Cover
Sections covered by this Questionnaire
Employee Details
Public Liability
Employers’ Liability
Plant - Own
Plant - Hired in
Business Equipment
Contract Works
Business Stock
Personal Accident - Princ/Ptnrs/Props
Professional Indemnity
Travel
Claims History
Client Details and General Information
Full Client NameAddress
Legal trading status
Business, company or partnership name
No. of partners
Trading name (if different from that under Proposer Details)
Address
Covers required
Activities
Business description
Trade (list all)
Maximum height worked at (metres)
Maximum depth worked at (metres)
Is gas work undertaken?
Is 3 Phase electrical work undertaken?
Declaration / Yes / No
There have been losses or incidents giving rise to losses in the last 5 years / /
You have a separate dedicated business premises / /
Your work involves discharge of fumes, effluent or anything of a noxious nature / /
Your work involves the use of substances which could be harmful to health / /
Details of heat equipment if used / Yes / No
Angle Grinders / /
Blow Lamps / /
Blow Torches / /
Flame Cutting Equipment / /
Hot Air Guns / /
Soldering Equipment / /
Welding Plant or Equipment / /
History
No. of years continuous experience in this trade
Year business established (yyyy)
Previous insurer
Description
Select any of the following that apply to any proposer, director or partner of the Trade or Business or its Subsidiary Companies if they have ever, either personally or in any business capacity / Yes / No
had any convictions or criminal offences which are not spent under the Rehabilitation of Offenders Act or has any prosecutions pending / /
been declared bankrupt or insolvent or been the subject of bankruptcy proceedings or insolvency proceedings / /
had a proposal refused or declined / /
had an insurance cancelled / /
had a renewal refused / /
had special terms imposed / /
Select all of the following that apply to any proposer/director/partner of the business/practice
Turnover (£)
Wageroll (next twelve months) (£)
All employees (inc. LOSC, trainees, apprentices) paid below PAYE threshold
Employer PAYE No
Period of Insurance
Effective DateTerm End Date
Scope of Cover
Sections covered by this Questionnaire
The following risks are covered in this questionnaire:
- Employee Details
- Public Liability
- Employers Liability
- Tools
- Plant - Own
- Plant - Hired in
- Business Equipment
- Contract Works
- Business Stock
- Business Interruption
- Personal Accident - Princ/Ptnrs/Props
- Personal Accident - Permanent Staff
- Professional Indemnity
- Travel
Employee Details
Covers RequestedTypes of staff - add all staff in company
Public Liability
Limit of indemnity (£)Employers’ Liability
Limit of indemnity (£)Plant - Own
Total market value of plant items (£)Sum insured (£)
Excess (£)
Plant - Hired in
Hiring charges (£)Sum insured (£)
Excess (£)
Business Equipment
Business equipment (£)Contract Works
Maximum value any one contract (£)Maximum contract site value (£)
Sum insured (£)
Excess (£)
Business Stock
Sum insured (£)Business Interruption
Limit of indemnity (£)Indemnity period (months)
Cover basis
Personal Accident - Princ/Ptnrs/Props
DetailsTitle / First name / Surname / Date of birth
Covers Requested
Cover basis
Capital benefit (£)
Weekly benefit (£)
Personal Accident - Permanent Staff
DetailsTitle / First name / Surname / Date of birth
Covers Requested
Cover basis
Capital benefit (£)
Weekly benefit (£)
Professional Indemnity
Maximum value any one contract (£)Largest single fee (£)
Sum insured (£)
Excess (£)
Retroactive date
Declaration
Do you undertake design work?
Details of design work
Accreditation
Travel
Geographical limitTotal annual person days
Claims History
Please see attached.
10/10/2018 / Tradesman Package Risk Questionnaire / 1