Contractors' Insurance Proposal Form

Complete 0%
1 Business 2 Liability 3 All Risks 4 Plant 5 Declaration

Contact Details

Enter reference/special offer code here:
Title*
First Name*
Last Name*
Email*
Telephone*
+44
  • Afghanistan +93
  • Albania +355
  • Algeria +213
  • American Samoa +1
  • Andorra +376
  • Angola +244
  • Anguilla +1
  • Antigua and Barbuda +1
  • Argentina +54
  • Armenia +374
  • Aruba +297
  • Australia +61
  • Austria +43
  • Azerbaijan +994
  • Bahamas +1
  • Bahrain +973
  • Bangladesh +880
  • Barbados +1
  • Belarus +375
  • Belgium +32
  • Belize +501
  • Benin +229
  • Bermuda +1
  • Bhutan +975
  • Bolivia +591
  • Bosnia and Herzegovina +387
  • Botswana +267
  • Brazil +55
  • British Indian Ocean Territory +246
  • British Virgin Islands +1
  • Brunei +673
  • Bulgaria +359
  • Burkina Faso +226
  • Burundi +257
  • Cambodia +855
  • Cameroon +237
  • Canada +1
  • Cape Verde +238
  • Caribbean Netherlands +599
  • Cayman Islands +1
  • Central African Republic +236
  • Chad +235
  • Chile +56
  • China +86
  • Christmas Island +61
  • Cocos +61
  • Colombia +57
  • Comoros +269
  • Congo - Kinshasa +243
  • Congo - Brazzaville +242
  • Cook Islands +682
  • Costa Rica +506
  • Côte d’Ivoire +225
  • Croatia +385
  • Cuba +53
  • Curaçao +599
  • Cyprus +357
  • Czech Republic +420
  • Denmark +45
  • Djibouti +253
  • Dominica +1
  • Dominican Republic +1
  • Ecuador +593
  • Egypt +20
  • El Salvador +503
  • Equatorial Guinea +240
  • Eritrea +291
  • Estonia +372
  • Ethiopia +251
  • Falkland Islands +500
  • Faroe Islands +298
  • Fiji +679
  • Finland +358
  • France +33
  • French Guiana +594
  • French Polynesia +689
  • Gabon +241
  • Gambia +220
  • Georgia +995
  • Germany +49
  • Ghana +233
  • Gibraltar +350
  • Greece +30
  • Greenland +299
  • Grenada +1
  • Guadeloupe +590
  • Guam +1
  • Guatemala +502
  • Guernsey +44
  • Guinea +224
  • Guinea-Bissau +245
  • Guyana +592
  • Haiti +509
  • Honduras +504
  • Hong Kong +852
  • Hungary +36
  • Iceland +354
  • India +91
  • Indonesia +62
  • Iran +98
  • Iraq +964
  • Ireland +353
  • Isle of Man +44
  • Israel +972
  • Italy +39
  • Jamaica +1
  • Japan +81
  • Jersey +44
  • Jordan +962
  • Kazakhstan +7
  • Kenya +254
  • Kiribati +686
  • Kosovo +383
  • Kuwait +965
  • Kyrgyzstan +996
  • Laos +856
  • Latvia +371
  • Lebanon +961
  • Lesotho +266
  • Liberia +231
  • Libya +218
  • Liechtenstein +423
  • Lithuania +370
  • Luxembourg +352
  • Macau +853
  • Macedonia +389
  • Madagascar +261
  • Malawi +265
  • Malaysia +60
  • Maldives +960
  • Mali +223
  • Malta +356
  • Marshall Islands +692
  • Martinique +596
  • Mauritania +222
  • Mauritius +230
  • Mayotte +262
  • Mexico +52
  • Micronesia +691
  • Moldova +373
  • Monaco +377
  • Mongolia +976
  • Montenegro +382
  • Montserrat +1
  • Morocco +212
  • Mozambique +258
  • Myanmar +95
  • Namibia +264
  • Nauru +674
  • Nepal +977
  • Netherlands +31
  • New Caledonia +687
  • New Zealand +64
  • Nicaragua +505
  • Niger +227
  • Nigeria +234
  • Niue +683
  • Norfolk Island +672
  • North Korea +850
  • Northern Mariana Islands +1
  • Norway +47
  • Oman +968
  • Pakistan +92
  • Palau +680
  • Palestine +970
  • Panama +507
  • Papua New Guinea +675
  • Paraguay +595
  • Peru +51
  • Philippines +63
  • Poland +48
  • Portugal +351
  • Puerto Rico +1
  • Qatar +974
  • Réunion +262
  • Romania +40
  • Russia +7
  • Rwanda +250
  • Saint Barthélemy +590
  • Saint Helena +290
  • Saint Kitts and Nevis +1
  • Saint Lucia +1
  • Saint Martin +590
  • Saint Pierre and Miquelon +508
  • Saint Vincent and the Grenadines +1
  • Samoa +685
  • San Marino +378
  • São Tomé and Príncipe +239
  • Saudi Arabia +966
  • Senegal +221
  • Serbia +381
  • Seychelles +248
  • Sierra Leone +232
  • Singapore +65
  • Sint Maarten +1
  • Slovakia +421
  • Slovenia +386
  • Solomon Islands +677
  • Somalia +252
  • South Africa +27
  • South Korea +82
  • South Sudan +211
  • Spain +34
  • Sri Lanka +94
  • Sudan +249
  • Suriname +597
  • Svalbard and Jan Mayen +47
  • Swaziland +268
  • Sweden +46
  • Switzerland +41
  • Syria +963
  • Taiwan +886
  • Tajikistan +992
  • Tanzania +255
  • Thailand +66
  • Timor-Leste +670
  • Togo +228
  • Tokelau +690
  • Tonga +676
  • Trinidad and Tobago +1
  • Tunisia +216
  • Turkey +90
  • Turkmenistan +993
  • Turks and Caicos Islands +1
  • Tuvalu +688
  • U.S. Virgin Islands +1
  • Uganda +256
  • Ukraine +380
  • United Arab Emirates +971
  • United Kingdom +44
  • United States +1
  • Uruguay +598
  • Uzbekistan +998
  • Vanuatu +678
  • Vatican City +39
  • Venezuela +58
  • Vietnam +84
  • Wallis and Futuna +681
  • Western Sahara +212
  • Yemen +967
  • Zambia +260
  • Zimbabwe +263
  • Åland Islands +358
Please enter your postcode and select your address*
House Number/Name

About the Business

Trading Name*
Your trading status is*
Please enter your company/charity registration*
Please describe your business status*
Partner 1 Full Name*
Partner 1 Telephone*
Partner 1 Email*
Partner 1 Address*
Add Second Partner*
Yes
No
Second Partner Full Name*
Second Partner Telephone*
Second Partner Email*
Second Partner Address*
Add Third Partner*
Yes
No
Third Partner Full Name*
Third Partner Telephone*
Third Partner Email*
Third Partner Address*
Add Fourth Partner*
Yes
No
Fourth Partner Full Name*
Fourth Partner Telephone*
Fourth Partner Email*
Fourth Partner Address*
Business Address*
Are you a member of a trade association/professional body?*
Yes
No
Professional Body*
Year Business Established*
Business Website Address

Business Activities

If you undertake more than one activity type in your business please select secondary and tertiary options and let us know the percentages.

 

Whether you choose 1,2 or 3 options they must equate to 100%

 

For example: Builder 70% Groundworker 30%

 

Primary Business Activity*
Your Business Activity*
Percentage
0 100
Secondary Business Activity*
Your Secondary Business Activity*
Secondary Percentage
0 100
Tertiary Business Activity*
Your Tertiary Business Activity*
Tertiary Percentage
0 100

Turnover Details

What is your anticipated turnover for the next 12 months?*

Please provide a breakdown of your turnover below

Premises Based Work*
Work away manual contracting*
Hazardous Locations*
Please select all hazardous locations that applyHold CTRL to select multiples
Payments to Bona Fides*
Non licensed asbestos removal*
Cost of materials*
Total Turnover
0.00

Height and Depth Work

Please state the maximum depth you work/dig to in metres*
Do you undertake any piling or underpinning work*
Yes
No
Please state the maximum height worked in metres
Please select the percentage of work carried out up to 15 metres height
0 100
Please select the percentage of work carried out up to 25 metres height
0 100
Please select the percentage of work carried out up to 50 metres height
0 100
Please select the percentage of work carried out over 50 metres in height
0 100

Other Business Activities

Do you undertake Steel Erection or Structural Steel Work*
Yes
No
Do you use slings, cradles, abseiling equipment or tower cranes*
Yes
No
Do any of your activities involve the use of heat?*
Yes
No
Hand held hot air guns*
Yes
No
Please state the percentage of work undertaken using hand held hot air guns work away?
0 100
Please state the percentage of work undertaken using hand held hot air guns at premises?
0 100
Blow lamps*
Yes
No
Please state the percentage of work undertaken using blow lamps work away?
0 100
Please state the percentage of work undertaken using blow lamps at premises?
0 100
Soldering irons, welding, cutting, grinding equipment or other equipment involving the application of heat*
Yes
No
Please state the percentage of work undertaken using soldering irons, welding, cutting, grinding equipment or other equipment involving the application of heat work away?
0 100
Please state the percentage of work undertaken using soldering irons, welding, cutting, grinding equipment or other equipment involving the application of heat at premises?
0 100
Back Next Save Progress

Call Us

01702 225400

This email address is being protected from spambots. You need JavaScript enabled to view it.

Monday to Friday 9am-5pm

For our joint protection calls may be recorded and/or monitored

Copyright Primo Plc 2018 | All Rights Reserved

Primo plc is registered in England and Wales, Reg No 1008700 at Cumberland House, Baxter Avenue, Southend-on-Sea, Essex SS2 6HZ
Tel: +44 (0)1702 225400

Primo Plc is authorised and regulated by the Financial Conduct Authority.

No Internet Connection