DARREN TEST of Capital Cover Combined Liability Submission

  • *Supporting CIRI - The Construction Industry Register of Ireland

    Instructions : Please fill out and click submit at the end of this page. We only accept electronically completed submission forms.

    WE DO NOT OFFER TERMS ON RISKS SUBMITTED ON RENEWAL DATE - PLEASE DO NOT COMPLETE THIS FORM IF THIS IS RENEWAL DATE. IT WILL NOT BE RESPONDED TO.

    FOR BEST RESULTS USE GOOGLE CHROME OR MOZILLA FIREFOX

    ***END OF YEAR WAGES & TURNOVER DECLARATION FORM CAN BE FOUND HERE***

  • NEW Combined Liability & Contractors All Risks Submission

  •  -
  • Are you the holding broker?*
  • Date Quote Required*
     - -
  • Are you a member of the CIF*
  • Are you a member of CIRI*
  • Does the proposer have an up to date Safety Statement?*
  • Do you perform any roofing only contracts?*
  • Do you engage in any hot roof work?*
  • Do you perform any demolition only contracts?*
  • Do you work in hazardous locations as outlined in our policy wording? (General Exclusion 9)*
  • Does the proposer engage in any manufacturing / fabrication at their own premises?*

  • Contract Details - complete at least one current or upcoming contract.

  • Completion Date*
     - -

  • Other Details

  • Height & Depth Limits

    Please confirm that all work undertaken by you will fall within the policy height and excavation limits selected below. 

  • Height Limit Required:*

  • Depth Limit Required*

  • Limits of Indemnity (Employers Liability €13,000,000 As Standard)

  • Wages & Turnover Information

  •  *Wages & Turnover figures should represent realistic projections for the intended annual period of insurance.*

    The term payments to employees means the total wages, salaries, and other earnings without any deductions in respect of employee PRSI, USC, income tax, holiday pay or contributory pension.

  • Insurance History

  • Are you now or have you in the past 5 years been insured for similar risk? CHOOSE NO IF NEW BUSINESS*
  • Renewal Date*
     - -

  • Claims History

  • Have any claims been made against you or incidents reported to you with in the last 5 years? *
  • Upload a File
    Cancelof

  • Include details of any outstanding Liability or CAR claims below if applicable.

  • Has any insurer declined to insure you, impose special terms, or refuse renewal?*

  • Contractors All Risks

  • Do you require a separate CAR quotation?*
  • Do you build timber frame houses?*

  • Disclosure:

    Any Material Fact must be disclosed to Insurers. i.e. Any information which may alter the judgment of an insurer in assessing the risk.Any material change must be disclosed to insurers. i.e. Any information which may alter the judgment of an insurer that has not previously been disclosed as material fact. Failure to provide all material facts and or notify of all material changes may cause the contract of insurance to be void and may result in Insurers repudiating liability entirely.

  • Date of Submission
     - -

  • PLEASE CLICK SUBMIT ONLY ONCE AND WAIT FOR YOUR CONFIRMATION MESSAGE

  • Should be Empty: