From what date is cover required?
*
/
Day
/
Month
Year
Date
Please state your annual income (gross income excluding VAT)
*
What level of public liability cover do you require?
*
£2m
£5m
£10m
Do you have any paid staff or helpers?
Yes
No
Please state your annual clerical wageroll
*
Please state your annual manual wageroll
*
Do you use any bonafide sub-contractors?
Yes
No
Do you require breach of professional duty cover?
Yes
No
Please state the level of cover required
*
£500,000
£1m
Do you require fidelity bonding cover?
Yes
No
Do you require financial loss cover?
Yes
No
Do you require cover for the loss of keys?
Yes
No
Do you require cover for vehicle immobilisation?
Yes
No
Do you require cover for property damage?
Yes
No
Buildings (standard construction)
Yes
No
Please state rebuilding cost
*
Portacabins (max £5,000 per item)
Yes
No
Please state reinstatement cost
*
Contents
Yes
No
Please state replacement cost
*
Stock
Yes
No
Please state replacement cost
*
Do you require business interruption cover?
Yes
No
Period of indemnity
*
12 months
24 months
Do you require cover for business money?
Yes
No
Do you require cover for goods in transit?
Yes
No
Do you require business all risks cover?
Yes
No
Laptops and computers
Yes
No
Please state replacement cost
*
Mobile phones
Yes
No
Please state replacement cost
*
Portable tools
Yes
No
Please state replacement cost
*
Do you require cover for your security dogs?
Yes
No
Please state how many dogs
*
Do you require personal accident cover whilst working?
Yes
No
Please provide your SIA licence number
Please provide your SIA licence expiry date
-
Month
-
Day
Year
Have there been any claims made in the last 3 years?
Yes
No
How would you prefer to be contacted by Cliverton?
Phone
Email
Please select the option which best describes your business:
*
Please Select
Limited Company
Trading As
Sole Trader
Title
*
Please Select
Dr
Miss
Mr
Mrs
Prof
Rev'd
Name
*
First name
Last name
Date of birth
*
/
Day
/
Month
Year
Address
*
Address line 1
Address line 2
City
Postcode
Email
*
Confirmation Email
Confirm email
Telephone
*
Please enter a valid phone number.
Is a joint policy required?
*
Yes
No
Title
*
Please Select
Dr
Miss
Mr
Mrs
Prof
Rev'd
Name
*
First name
Last name
Date of birth
*
/
Day
/
Month
Year
Date
SUBMIT
Should be Empty: