1. (a) Estimated total annual wage including remuneration
of working partners and directors
Own premises
Work elsewhere
(b) Estimated total annual payments to sub-contractors
Own premises
Work elsewhere
2. Have you any vehicles or cycles which are not
powerdriven?
*If so, give particulares
YES
3. (a) Have you any good lifts, cranes, or hoists?
* If so,
give situation and description of each
YES
(b) Are these regularly inspected to comply with statutory
requirements?
YES
(C) If so, by whom
4. Give details of any mobile plant and/or vehicles not
licensed for road use
5. State what acids, gases, chemicals, explosives or
radioactive materials will be used, and to what extent
6. Have you ever been insured against this kind of risk
before? If so, state name of company
and if this company, give policy number
7. Has any company or underwriter, in respect of a
similar insurance
(b) refused to renew your policy?
(c) increased your premium on renewal?
8. Give particulars of all claims made upon you during the
past three years
9. Are your boilers insured against explosion? If so, by
whom?
10. Please state the limits of indemnity required for any
one accidentNote: The amount of indemnity in any one
period of insurance is unlimited except for claims for food poisoning or
defective workmanship or products
11. Is cover required for: (a) Food poisoning
(b) fire and explosion
(c) Any other special extensions? if so give full
particulars
