Pest Control

Title*
Name*

First nameLast name
Date of birth*

DayMonthYear
Is a joint policy required?*

YesNo
Title*
Name*

First nameLast name
Date of birth*

DayMonthYear
Full trading name*
Please select the option which best describes your business:*
Full postal address*

Address line 1

Address line 2

City

Postcode
Email*

Confirmation EmailConfirm email
Telephone*
Please enter a valid phone number.
Are you a member of the British Pest Control Association (BPCA) or the National Pest Technicians Association (NPTA)?*

YesNo
Please provide your membership number
Have you or your business partners or directors ever had an insurance proposal declined, renewal refused or insurance cancelled or special terms applied?*

YesNo
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?*

YesNo
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?*

YesNo
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?*

YesNo
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?*

YesNo
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?*

YesNo
Do you or your business partners or directors have any companies or business in any sanctioned territory?*

YesNo
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?*

YesNo
Do you or your business partners or directors have any involvement with any products or components associated with weaponry, arms or military goods?*

YesNo
Have you or your business partners or directors had any claims, losses or incidents in the last three years?*

YesNo
If yes, please provide further information
Do you currently have insurance in place?*

YesNo
If yes, who is your current insurer? Please note, we cannot quote against Aviva
If no, is this a new business venture?

YesNo
If no, how long have you been trading?
Do you use firearms in connection with your business activities?*

YesNo
Do you hold a valid shotgun/firearms certificate?*

YesNo
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?*

YesNoN/A
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)*

YesNo
What date should your policy commence? (Please note we cannot back date cover)*

DayMonthYear
About your business - Please provide a brief description of your business activities *
Policy Cover - Applicable Trades
Please select which business activities you require cover for:*

Pest, vermin and weed controlLitter pickingBird deterrentBed bug detection and destructionHuman destruction of road injured animalsSpraying against flies, rodent operators, rabbit controlFalconry (includes bird deterrent, public displays on and off site, static displays on and off site, lectures and educational visits on and off site, hawking and hunting days (including the use of ferrets and dogs), catering and refreshments, wedding ring delivery service)Use of bangersUse of scarecrowsUse of airguns, shotguns and rifles (provided that you comply with the Use of Guns Condition in the policy wording)
Activities incidental (no more than 25% turnover generated from activities in total) to your primary trades:*

Facilities managementGeneral maintenanceHorticultural/garden maintenance and landscape gardeningN/A
Do you require cover to work at any of the below hazardous locations?

Blast furnacesChimney or well shaftsViaductsBridgesMinesRefineriesOff-shore installationsPower stationsDamsTunnelsAirportsAerodromesDocksWharvesPiersHarboursRailwaysMotorwaysShipsAircraftTowes or steeples
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?*

YesNo
Any work from ladders over 10 meters?*

YesNo
Any work involving the use of drones?*

YesNo
Do you or your business partners or directors hold a current zoo license?*

YesNo
Do you offer birds of prey displays at events with an attendance greater than 1000?*

YesNo
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*

YesNo
Prosecuted under Product Safety legislation*

YesNo
Forced to issue a product recall by the enforcing authorities*

YesNo
Public Liability Compulsory Sections
Please select the level of cover required*

£5m£10m
Please state your annual turnover (Your gross income excluding VAT)*
Do you use any bonafide sub-contractors?*

YesNo
If yes, please state your estimated annual payments to Bona Fide sub-contactors
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?*

YesNo
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.*

YesNo
If you currently have professional indemnity cover in place, please confirm the date of commencement (retroactive date):

DayMonthYear
Date
If yes, please select the level of cover required*

£500,000£1m
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.*

YesNo
Have there been any incidents concerning damage to or theft of your customers property?*

YesNo
Have there been any police investigations of any of your employees?*

YesNo
Do you require financial loss cover? This covers your legal liability for financial loss incurred by others for claims made against you.*

YesNo
If yes, please select the level of cover required

£50,000£250,000
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.*

YesNo
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.*

YesNo
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?*

YesNo
Do any employees work from heights over 10 meters?*

YesNo
If yes, what percentage of their work consists of working at heights over 10 meters?*

0 - 25%25% -- 50%Over 50%
Please state your annual wage roll for clerical / administrative staff*
Please state your annual wage roll for all other manual employees*
Please state your annual wage roll for self employed staff (labour only sub-contractors)*
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.*

YesNo
If no, please provide your ERN
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.*

YesNo
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.*

YesNo
Please confirm that you have never been prosecuted by the Crown Prosecution Service under the Corporate manslaughter and Corporate Homicide Act 2007*

YesNo
Please confirm you and your business obtain written references and identity checks for all Employees*

YesNo
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?

YesNo
Please confirm procedures are in place to fully train and supervise employees?

YesNo
Please confirm all equipment is tested and inspected in accordance with current legislation?

YesNo
Please confirm risk assessments are carried out for all contracts, and method statements are provided to all employees?

YesNo
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?

YesNo
If you have answered No to any of the health and safety questions, please provide further detail below:
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?*

YesNo
Do you work offshore?*

YesNo
Do you pilot any aircraft?*

YesNo
Do you work at depth and / or mining?*

YesNo
Do you work as a diver?*

YesNo
Do you work above height of 10 meters?*

YesNo
Please state the name and occupation of all employees to be covered:
Please state the total wage roll for all employees to be covered
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?*

YesNo
If yes, please state your reinstatement value:*
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?*

YesNo
If yes, please state the required period of indemnity*

12 months24 months
If yes, please state the estimated gross profit including all wageroll
If yes, please state your increased cost of working
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?*

YesNo
Buildings (standard construction)

YesNo
Please state rebuilding cost*
Portacabins

YesNo
Please state reinstatement cost*
Contents

YesNo
Please state replacement cost*
Tools of trade

YesNo
Please state replacement cost*
Trailers

YesNo
Please state replacement cost*
Stock

YesNo
Please state replacement cost*
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?

YesNo
Have the premises suffered from or showing any signs of damage by subsidence, ground heave or landslip?

YesNo
Are the premises situated over made up ground or underground workings of any sort, or sited near a cliff?

YesNo
Are the premises occupied for the sole purpose of the business and otherwise only as private dwellings?

YesNo
Are the premises unfurnished, unused or unoccupied?

YesNo
Can the portions of the premises you occupy be seperately locked to prevent access?

YesNo
Are the premises located in an area with a history of flooding?

YesNo
Are the premises you occupy protected by adequate security devices and / or intruder alarm systems?

YesNo
Please provide the full risk address where property is stored.
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?*

YesNo
Laptops and computers

YesNo
Please state the full replacement cost*
Mobile phones

YesNo
Please state the full replacement cost*
Portable tools

YesNo
Please state the full replacement cost*
Trailers

YesNo
Please state the full replacement cost*
Hired in plant

YesNo
Please state the full replacement cost*
Annual hire charge*
Single Article Limit (This is the maximum your insurers will pay for any one item)*
Do you require cover for business money?*

YesNo
How would you prefer to be contacted by Cliverton?*

PhoneEmail
Would you like to receive news and updates from Cliverton?*

YesNo
Where did you hear about Cliverton? *
If 'other', please state where: *
Should be Empty: