Your details
Title
*
Please Select
Dr
Miss
Mr
Mrs
Prof
Rev'd
Name
*
First name
Last name
Date of birth
*
/
Day
/
Month
Year
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
Full trading name:
*
Full postal address
*
Address line 1
Address line 2
City
Postcode
Email
*
Confirmation Email
Confirm email
Telephone
*
Please enter a valid phone number.
Have you or your business partners or directors ever had an insurance proposal declined, renewal refused or insurance cancelled or special terms applied?
*
Yes
No
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 respect of any criminal offence, other than a minor motoring offence which are not spent under the Rehabilitation of Offenders Act?
*
Yes
No
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?
*
Yes
No
In the last 10 years, have you or your business partners or directors been ever been the subject of a County Court Judgement , an Individual Voluntary Arrangement, a Company Voluntary Arrangement or a Sheriff Court Decree?
*
Yes
No
In the last 10 years, the business has not been subject to an investigation by HM Revenue and Customs which has resulted in a prosecution?
*
Yes
No
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?
*
Yes
No
Do you or your business partners or directors have any companies or business in any sanctioned territory?
*
Yes
No
Do you or your business partners or directors export to or operate in any sanctioned territory or have any business dealings with individuals or entities that are known to be sanctioned under United Nations resolutions or the trade or economic sanctions laws or regulations of the European Union, United Kingdom or United States of America or any of its states?
*
Yes
No
Do you or your business partners or directors have any involvement with any products or components associated with weaponry, arms or military goods?
*
Yes
No
Have you or your business partners or directors had any claims, losses or incidents in the last three years?
*
Yes
No
If yes, please provide further details:
Your business details
Do you currently have insurance in place?
*
Yes
No
If no, is this a new venture?
*
Yes
No
If no, how long have you been trading?
*
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)
*
Yes
No
What date should your policy commence? (Please note we cannot back date cover)
*
/
Day
/
Month
Year
Date
Please provide a brief description of your business activities:
*
Please select all activities which apply to your business:
*
General purpose security guarding with and without dogs (Excluding door supervision and crowd control services)
CCTV installation / monitoring
Unarmed close protection of UK domiciled clients only
Drug and explosive detection
Dog and handler training
Public event stewarding with and without dogs
Bailiff assistance with animal containment
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 door supervision of licensed premises or venues including pubs, clubs, hotels and ‘beer tents’?
*
Yes
No
Any crowd control services such as pitch side stewarding or front of stage crowd control?
*
Yes
No
Any public event event stewarding at events with an attendance of greater than 1000?
*
Yes
No
Public Liability
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 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?
*
Yes
No
Prosecuted under Product Safety legislation?
*
Yes
No
Forced to issue a product recall by the enforcing authorities?
*
Yes
No
Compulsory sections:
What level of public liability cover do you require?
*
£2m
£5m
£10m
Please state your annual turnover (your gross income excluding VAT)
*
Do you use any bonafide sub-contractors?
*
Yes
No
If yes, please state your estimated annual payments to Bona Fide 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?
*
Yes
No
Public Liability - optional extensions
Please state if cover is required.
Do you require efficacy cover? This covers your failure perform the duties you have been contracted for.
*
Yes
No
Do you require professional indemnity cover? This covers you for claims made against you for a breach of duty of care, or any negligent acts, errors or omissions.
*
Yes
No
If you currently have professional indemnity cover in place, please confirm the date of commencement (retroactive date):
-
Day
-
Month
Year
Date
Please state the level of cover required
*
£500,000
£1m
£2m
Do you require cover for cask carrying services?
*
Yes
No
If yes, please provide your attributable turnover for this activity:
*
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.
*
Yes
No
Have there been any incidents concerning damage to or theft of your customers property?
*
Yes
No
Have there been any police investigations of any of your employees?
*
Yes
No
Do you require financial loss cover? This covers your legal liability for financial loss incurred by others for claims made against you.
*
Yes
No
Do you require cover for vehicle immobilisation services?
*
Yes
No
If yes, please provide your attributable turnover for this activity:
*
Employers' Liability
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 anguish, 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?
*
Yes
No
Do you have an ERN/PAYE reference number for your business?
*
Yes
No
If yes, please provide below:
*
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?
*
Yes
No
Please confirm procedures are in place to fully train and supervise employees?
*
Yes
No
Please confirm all equipment is tested and inspected inaccordance with current legislation?
*
Yes
No
Please confirm risk assessments are carried out for all contracts, and method statements are provided to all employees?
*
Yes
No
If no, please provide further details:
*
Personal accident section
This section covers an injury sustained during the course or in connection with the described occupation, excluding any sickness or illness and injuries resulting from commuting to and from work.
Do you require cover for personal accident?
*
Yes
No
Do you work off-shore?
*
Yes
No
Do you pilot any aircraft?
*
Yes
No
Do you work at depth and/or mining?
*
Yes
No
Do you work as a diver?
*
Yes
No
Do you work above height of 10 meters?
*
Yes
No
Do you need personal accident cover for any employees?
*
Yes
No
If yes, 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 damage to property belonging to you or held in trust for which you are responsible while in transit anywhere within the UK.
Do you require cover for goods in transit?
*
Yes
No
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?
*
Yes
No
Period of indemnity
*
12 months
24 months
Please state the estimated gross profit including wage roll:
*
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?
*
Yes
No
If yes, please state reinstatement cost for each type of property required:
*
Reinstatement cost
Buildings (Standard construction)
Buildings (Non-standard construction)
Portacabins (Max £7,500 any one structure)
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?
*
Yes
No
Have the premises suffered from or showing any signs of damage by subsidence, ground heave or landslip?
*
Yes
No
Are the premises situated over made up ground or underground workings of any sort, or sited near a cliff?
*
Yes
No
Are the premises occupied for the sole purpose of the business and otherwise only as private dwellings?
*
Yes
No
Are the premises unfurnished, unused or unoccupied?
*
Yes
No
Can the portions of the premises you occupy be seperately locked to prevent access?
*
Yes
No
Are the premises located in an area with a history of flooding?
*
Yes
No
Are the premises you occupy protected by adequate security devices and / or intruder alarm systems?
*
Yes
No
Do any of your premises consist of flat roofed areas?
*
Yes
No
Please provide the full risk address where property is stored:
*
Street Address
Street Address Line 2
City
County
Post code
Do you require cover for any contents?
*
Yes
No
If yes, please state reinstatement cost for each type of contents cover:
*
Replacement cost
Tools of the trade
General commercial contents
Commercial stock
Trailers (own premises only)
Do you require loss of use cover for your security dog? This is available for dogs up to the age of 6 years old and is subject to a vets report confirming they are healthy and fit for duty.
*
Yes
No
Please state how many dogs
*
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?
*
Yes
No
If yes, please provide the reinstatement cost for each section of cover required:
*
Reinstatement cost
Electronic equipment (Inc. mobile phones, laptops and computers)
Portable tools (used away from the premises and not stored at the premises permanently)
Trailers (away from premises only)
Hired in plant
Do you require cover for vehicle immobilisation?
*
Yes
No
Do you require cover for business money?
*
Yes
No
Please state replacement cost
*
Please provide your SIA licence number
*
Please provide your SIA licence expiry date
*
-
Month
-
Day
Year
How would you prefer to be contacted by Cliverton?
*
Phone
Email
Where did you hear about Cliverton?
*
Please Select
Facebook
Instagram
TikTok
Google search
Word of Mouth
Friend or family
NASDU
Other
If 'other', please state where:
*
Would you like to receive news and updates from Cliverton?
*
Yes
No
SUBMIT
Should be Empty: