CONTRACTORS ALL RISK

1
Name of insured
2
Insured VAT No
3
Insured Company Reg No
4
Postal Address
5
Insured Telephone No.
6
Insured Cell No
7
Insured email address
example@example.com
8
Name of Main Contractor
9
Name of Principal Employer
10
Name of sub contractors
11
Name of broker
Please Select
Please Select
Addsure - telephone 021 5515069
Other broker
12
Estimated annual turnover
13
Description of the type of Contracts entered into (Erection, Alterations, Extensions to Buildings/Dwellings etc.)
14
The value of the largest contract to be worked on / awarded during the next 12 months:
15
In which areas will the Contracts take Place?
16
What work will be done by Sub Contractors
17
Surrounding property under custody/controlNOT PART OF CONTRACT WORKS
18
Limit of indemnity required?(How much cover needed?)
19
Inception Date of Policy
Date
Day
Month
Year
20
Maintenance Period Required
21
SASRIA required YES or NO?
YESNO
22
Contractors Public Liability: Limit of Indemnity Required LIABILITY SECTION
23
Use of explosives?
YESNO
24
Removal of support (lateral support)?
YESNO
25
Claims Experience Details
26
Any notes to add at end of form?
Huge
Large
Normal
Small
Ok
Ok
27
SIGNED BY INSURED
Clear
28
DATE
Date
Day
Month
Year
Should be Empty: