Risk Details - Sums Insured & Limits Required
Employers Liability	£
Public Liability	£
Product Liability	£
Excess Required	£

Employees & Sub-Contractors
Please estimate the annual payments to all employees and other persons in the following groups:
Description of Persons Employed	Payroll of Those working at your Premises	Payroll of those who work away from your Premises
Clerical, Commercial Travellers and Managerial employees who do NOT work manually	£	£
Woodworkers, Machinists and their Labourers	£	£
All other direct employees	£	£
Labour only Sub-Contractors and self-employed persons for labour only	£	£
All other Sub-Contractors	£	£
Proposer of working manually in the business	£	£

Turnover & Exports
Do you Export	Yes No
Do you Import	Yes No
Please state annual Turnover	£
Turnover in United Kingdom	£
Turnover for Canada & USA	£
Turnover for rest of World	£

Claims & Previous Insurance
Give Details of ALL claims including Industrial Diseases made on you in the last 5 years, giving dates, amounts settled and /or including outstanding claims. If none please state "None".	None
Has Any Insurer ever :
Declined your Proposal ?	Yes No
Cancelled or refused to renew your Insurance ?	Yes No
Required an increased Premium or imposed special Terms ?	Yes No
If you have answered Yes to any of the last 3 questions, please give full details. Also give details of other Material Facts.	-
Are you currently Insured ?	Yes No
Name of your current Insurers
Renewal Date	(In "dd / mm / yyyy" format eg. Xmas is 25 /12 /1998)
Current Premium	£