• Date of birth*
     / /
  • Is a joint policy required?*
  • Date of birth*
     / /

  •
  • Format: 00000 000000.
  • Are you a member of the British Pest Control Association (BPCA) or the National Pest Technicians Association (NPTA)?*
  • Have you or your business partners or directors ever had an insurance proposal declined, renewal refused or insurance cancelled or special terms applied?*
  • Have you or your business partners or directors ever been convicted of or charged (but not yet tried) or been given an official police caution in repsect of any criminal offence, other than a minor motoring offence which are not spent under the Rehabilitation of Offenders Act?*
  • In the last 10 years, have you or your business partners or directors been declared bankrupt or insolvent or been the subject of bankruptcy proceedings or insolvency proceedings or been disqualified from being a company director?*
  • In the last 10 years, have you or your business partners or directors been ever been the subject of a County Court Judgement , an Induvidual Voluntary Arrangement, a Company Voluntary Arrangement or a Sheriff Court Decree?*
  • In the last 10 years, the business has not been suject to an investigation by HM Revenue and Customs which has resulted in a prosecution?*
  • Is your business owned by an individual or entity which appears on the financial sanctions list of the United Nations, the European Union, United Kingdom or United States of America or any of its states?*
  • Do you or your business partners or directors have any companies or business in any sanctioned territory?*
  • Do you or your business partners or directors export to or operate in any sanctioned territory or have any business dealings with induviduals or entities that are known to be sanctioned under United Nations resolutions or the trade or economic sanctions laws or regulations of the Eurpoean Union, United Kingdom or United States of America or any of its states?*
  • Do you or your business partners or directors have any involvement with any products or components associated with weaponry, arms or military goods?*
  • Have you or your business partners or directors had any claims, losses or incidents in the last three years?*
  • Do you currently have insurance in place?*
  • If no, is this a new business venture?
  • Do you use firearms in connection with your business activities?*
  • Do you hold a valid shotgun/firearms certificate?*
  • Do you and your business partners and directors ensure that all statutory regulations are complied with in respect of the ownership, storage and use of firearms where business activities include the use of firearms?*
  • Do you have a risk assessment in place for your business? Please note, (Cliverton do not need sight of these but in the event of a claim your insurers may ask for copies, it is a condition of the policy that these are in place)*
  • What date should your policy commence? (Please note we cannot back date cover)*
     / /

  • Policy Cover - Applicable Trades 

  • Please select which business activities you require cover for:*
  • Activities incidental (no more than 25% turnover generated from activities in total) to your primary trades:*
  • Do you require cover to work at any of the below hazardous locations?

  • Policy Cover - Exclusions

    Please confirm you DO NOT undertake any of the following activities. If you answer yes to any of the below, we will need to refer to our underwriters to obtain cover for you. We may also ask for further information to assist the underwriters. 

     

  • Any work from heights of over 20 meters?*
  • Any work from ladders over 10 meters?*
  • Any work involving the use of drones?*
  • Do you or your business partners or directors hold a current zoo license?*
  • Do you offer birds of prey displays at events with an attendance greater than 1000?*

  • Public Liability Section

    This section covers you for your legal liability including related legal costs, if someone is injured or their property is damaged as a result of your business activities, and where they can demonstrate that their loss is due to your negligence.

     

    Please confirm that you have NOT been:

  • Prosecuted by the Environment Agency and / or been subject to Civil Sanctions and / or been required to pay clean-up costs following a pollution incident*
  • Prosecuted under Product Safety legislation*
  • Forced to issue a product recall by the enforcing authorities*

  • Public Liability Compulsory Sections

  • Please select the level of cover required*
  • Do you use any bonafide sub-contractors?*
  • If you engage the use of Bona Fide sub-contractors, do you check that they hold Public Liability Insurance, including efficacy cover, with a limit of indemnity of at least £1,000,000?*

  • Public Liability optional Extensions - Please state if covered is required. 

  • Do you require Professional Indemnity cover? This covers you for any claims made against you for a breach of duty of care, or any negligent acts, errors or omissions.*
  • If you currently have professional indemnity cover in place, please confirm the date of commencement (retroactive date):
     - -
  • If yes, please select the level of cover required*
  • Do you require fidelity cover? This covers your legal liability for damages you may be liable to pay to any party arising solely as a result of any acts of fraud or dishonesty by any of your employees, up to a limit of £50,000.*
  • Have there been any incidents concerning damage to or theft of your customers property?*
  • Have there been any police investigations of any of your employees?*
  • Do you require financial loss cover? This covers your legal liability for financial loss incurred by others for claims made against you.*
  • If yes, please select the level of cover required
  • Do you require cover for the misuse of telephones? This covers your legal liability to your customers for their financial loss incurred due to the unauthorized use of their telephones by your employees, up to a limit of £5,000.*
  • Do you require cover for the temporary removal of customers' property? This covers your legal liability for damage to customers property whilst temporarily removed for the purpose of treatment, cleaning, repair or renovation, up to the limit of £10,000 for any one customer.*

  • Employers' Liability Section

    This section covers you for damages and costs which you are legally liable to pay in respect of bodily injury, for example, death, injury, illness, disease, mental injury and anquish, to an employee. You are legally obliged to arrange employers' liability insurance if you have paid employees and certain types of voluntary helpers.

  • Do you require employers' liability insurance?*
  • Do any employees work from heights over 10 meters?*
  • If yes, what percentage of their work consists of working at heights over 10 meters?*
  • Is your business exempt for Employer Reference Number purposes? Please note your business may be exempt from this if the entire workforce is voluntary, self employed, or where all employees are paid below the PAYE threshold.*
  • Please confirm that you have never been prosected by the health and Safety Executive or been notified that a prosecution will be made and / or received Prohibition or Improvement Notices for breaches of health and safety.*
  • Please confirm that you have never been prosecuted by an enforcing authority or been notified that a prosecution will be made and / or received Enforcement or Prohibition Notices for breaches in fire safety.*
  • Please confirm that you have never been prosecuted by the Crown Prosecution Service under the Corporate manslaughter and Corporate Homicide Act 2007*
  • Please confirm you and your business obtain written references and identity checks for all Employees*

  • Your Health and Safety Procedures

  • Are all of your employees trained to the required Health and Safety standards and training records are kept up to date?
  • Please confirm procedures are in place to fully train and supervise employees?
  • Please confirm all equipment is tested and inspected in accordance with current legislation?
  • Please confirm risk assessments are carried out for all contracts, and method statements are provided to all employees?
  • Please confirm in respect of work at height (up to a maximum of 20 metres) all employees are fully trained and issued with safety equipment, and such training and equipment is fully documented and recorded?

  • Personal Accident Section

    This section covers an injury sustained during the course or in connectiion with the described occupation, excluding any sickness or illness and injuries resulting from commuting to and from work.

  • Do you require personal accident cover?*
  • Do you work offshore?*
  • Do you pilot any aircraft?*
  • Do you work at depth and / or mining?*
  • Do you work as a diver?*
  • Do you work above height of 10 meters?*

  • Goods in Transit 

    This section covers you for the damage to property belonging to you or held in trust for which you are responsible while in transit anywhere in the UK.

  • Do you require cover for goods in transit?*

  • Business Interruption 

    This section covers you for a loss of income following an interruption or interference with the business resulting from damage to property used by you at the premises.

  • Do you require business interruption cover?*
  • If yes, please state the required period of indemnity*

  • Property damage and theft 

    This section covers buildings, contents, stock and tools belonging to you, for loss or damage at your home or business premises.

  • Do you require cover for property damage?*
  • Buildings (standard construction)
  • Portacabins
  • Contents
  • Tools of trade
  • Trailers
  • Stock
  • Are the premises built solely of brick, stone or concrete and roofed solely of slate, tile, concrete or metal and maintained in a good state of repair?
  • Have the premises suffered from or showing any signs of damage by subsidence, ground heave or landslip?
  • Are the premises situated over made up ground or underground workings of any sort, or sited near a cliff?
  • Are the premises occupied for the sole purpose of the business and otherwise only as private dwellings?
  • Are the premises unfurnished, unused or unoccupied?
  • Can the portions of the premises you occupy be seperately locked to prevent access?
  • Are the premises located in an area with a history of flooding?
  • Are the premises you occupy protected by adequate security devices and / or intruder alarm systems?

  • Business All Risks 

    This section covers your specific property such as mobile phones, laptops and trailers against damage whilst away from your premises within Great Britain and Northern Ireland, including accidental damage cover. It can also provide cover for equipment hired in by you for your use, if it is lost, damaged or stolen whilst in your care.

     

  • Do you require business all risks cover?*
  • Laptops and computers
  • Mobile phones
  • Portable tools
  • Trailers
  • Hired in plant
  • Do you require cover for business money?*
  • How would you prefer to be contacted by Cliverton?*
  • Would you like to receive news and updates from Cliverton?*
  • Should be Empty: