BusinessInsuranceQuotations.com Motor Trade Road Risk Liability Insurance Proposal Form   Please note that you may e-mail or fax your schedule of vehicles to us. You may e-mail to chris@BusinessInsuranceQuotations.com or Fax to 029 2071 2919 1. Your Name:  Post Code:            Telephone Number:  E-mail address:

PUBLIC AND PRODUCT LIABILITY This covers your legal liability to customers and members of the public for injury to them or damage to their property arising from your declared activities at your premises or whilst working away Public Liability cover required: £ 1M2M3M5MNone Products Liability cover required: £ 1M2M3M5MNone Service Indemnity cover required: £ 250,0001M2M3M5MNone Sales Indemnity cover required: £ 1M2M3M5MNone What is your projected annual turnover £ Do you weld or cut on your own premises?  Yes No Do you weld or cut away from your premises?  Yes No Do you spray on your own premises?  Yes No Do you spray away from your premises?  Yes No EMPLOYER'S LIABILITY    Do you require cover for Employer's Liability? (Standard indemnity is £10,000,000)  Yes No Have you ever been prosecuted under the Factories Act, the Health & Safety at Work Acts or other Statutory Regulations  Yes No Have you previously been insured for Employer's Liability cover?  Yes No ENGINEERING PLANT Cover Required Statutory InspectionStatutory Inspection and Insurance CoverStatutory Inspection and Insurance and Breakdown Cover- Air Receiver (quantity of) Mechanical Winch (quantity of) Electrical Winch (quantity of) Lifting Table (quantity of) Trolley Jacks (quantity of) Lifting Tackle (quantity of) Welding Sets (quantity of) Do you have an MOT inspection licence?  Yes No  If yes, annual MOT fee income, and £  income from repairs following MOT failure £ CURRENT INSURERS  Name of current insurers (so that we don't approach them!)  Expiry date of current insurance  Current premium (if known) £   You may e-mail to chris@BusinessInsuranceQuotations.com or Fax to 029 2071 2919 Please supply me with an estimate within 105 working days. (We will attempt to meet the target, but please be aware that it does require our insurers to respond quickly as well!) Done