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Alarm & Security Installers Liability Enquiry Form
Contact Details
Contact Name* :
A value is required.
Trading Name:
Business Address:
Town/City :
County/District :
Postcode :
Daytime telephone* :
A value is required.
Fax number :
Mobile number :
Email* :
A value is required.
Invalid format.
General Information
How did you hear about us?:
No. years trading:
Current Insurer :
Renewal date
(dd/mm/yyyy)
:
A value is required.
Format: dd/mm/yyyy
Current premium :
Does it provide efficacy? :
Yes
No
Are you a member of any inspectorates or professional bodies? :
NACOSS
SSAIB
Other
(Specify below)
Business type :
Sole trader
Partnership
Limited Company
Business Activities
(Must total 100%)
Business Activity
%age of Work
Business Activity
%age of Work
Intruder Alarms:
Fire Alarms:
CCTV :
Access Control:
Grills/Barriers:
Lighting:
Smoke Emitting:
Key Holding:
General Electrical:
Other Activities:
(Please specify):
Work Performed at Height and/or with Heat
Height
(Must total 100%)
:
Ground to 3m:
3m to 16m:
Over 16m:
Heat Soldering Irons** :
Naked Flame** :
**Heat work need not total 100%
Claims History
Number of Claims in the past 5 years* :
A value is required.
Please provide details below of any claims in the past 3 years, this should include
the date of the loss, the cause and the claim settlement cost.
Limits of Indemnity
Employers Liability required?:
Yes
No
Limit:
£
Public & Products liability:
Including professional advice
£
Efficacy:
£
No. Staff Employed:
Key Loss:
£
Financial Estimates
Clerical/Admin Wageroll:
£
Manual Wageroll:
£
Gross Annual Turnover:
£
Loss of keys (sets):
Other Insurances
Do we already hold any of your other insurance policies?
We can also provide cover for your trading premises, personal household and motor. Will you let us quote to see if we can improve on your existing arrangements?
If we already provide your Liability Insurance, you will automatically qualify for a 7.5% introductory discount on your home and/or commercial premises insurance if you buy them through us.
Complete the fileds below to let us know when they are due for renwal and we will contact you nearer the time to discuss your exact requirements.
Commercial Premises
Required :
Yes
No
Current Insurer:
Next Renewal Date:
Current Premium:
£
Household Insurance
Required :
Yes
No
Current Insurer:
Next Renewal Date:
Current Premium:
£
Motor Insurance
Required :
Yes
No
Current Insurer:
Next Renewal Date:
Current Premium:
£
Vehicle 1 - Make, Model and Registration Mark:
Vehicle 2 - Make, Model and Registration Mark:
Vehicle Make 3 - Make, Model and Registration Mark:
More than 3 vehicles in your fleet?:
Yes
No
Contact Preference
Contact Method:
Phone (daytime number)
Phone (mobile)
Email
Time of Day:
Anytime (9-5)
Morning
Afternoon
*Compulsory Field
SISS Insurance will not share the information above outside of Apex Insurance Services Limited and the details will only be used for the purposes of providing a fully tailored household insurance quote. Please indicate below if you DO want to receive any future correspondence or information on new products, special offers and updates from SISS Insurance/Apex Insurance Services Limited.
Email
Post
Telephone (Daytime Number)
Telephone (Mobile)
I confirm that the information provided above is accurate and correct:
Please confirm.
