Name of Company      

Address of Company

Post Code                     

Nature of business     Sole Trader Partnership Limited Company Other      

Trade or Occupation 

Public Liability
Indemnity required      5 million 2 million 1 million

Number of Partners, Principals or Directors 
not engaged in manual work

Number of Partners, Principals or Directors 
engaged in manual work

Number of manual worker employees             
(including sub contractors) 
excluding Partners, Principals or Directors                               

Number of clerical employees                             
excluding Partners, Principals or Directors  

Do you carry out window cleaning above 4 storeys?  Yes No

Do you use cradles or abseiling equipment?              Yes No

Is your business currently insured?                             Yes No

Additional cover required:            Employer's Liability        
(This section is not available for companies involved in window cleaning)

Please confirm that the following statement is correct

I/We have experience in the type of work to which this request for a quotation relates.
I/We have not been involved in any incidents in the last five years which did give or could have given rise to a claim of a type which this insurance is intended to cover.
I/We do not use woodworking machinery, other than handheld portable power tools.
I/We do not use oxy-acetylene or similar equipment.
I/We do not work below 1 metre or above 22 metres height.
I/We do not come into contact with explosives, gases, toxic or corrosive chemicals, radioactive substances, asbestos or silica.
I/We do not undertake underpinning

I/We confirm that the above statements are true

Date from which you need cover to start (dd/mm/yyyy)    

Please enter below any further information that you think we should know  before preparing your quotation.

Tell us how to get in touch with you:

Please contact me as soon as possible regarding this matter.

Your initial quote, plus details of the extra cover you have requested will be sent to you by email or fax

The information you have provided  will only be used to allow us to prepare your quotation.  

We do not share our information with any organisation outside our own group other than for the purposes of placing and servicing your insurance. 

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Please check this box if you do not wish us to notify you of other products 

which we believe may be of interest.

        Download a policy summary

Copyright ©  [Harvington Services Ltd]. All rights reserved.
Revised: June 19, 2008 .