Exclusively Cleaning Proposal Page 2
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9Exclusively Cleaning Proposal
Agent
Agent code
Insurance to commence on
for 12 months
Policy No.
Proposer’s name
Show the full name, including any subsidiary companies to be insured. If not a limited company show the full names of all principals and partners and any trading name.
If you have been trading for less than 12 months, please provide details of the background of Directors/Partners including number
of years’ experience in the Cleaning Industry:
Company Registration Number
Date business established
/
/
Email address
Tel No
Website address
Postal address
Postcode
Business description
Please provide a full description of your business activities including those of any subsidiary companies to be insured.
If you require Employers’ Liability cover, please provide your Employer PAYE Reference(s) below. (This information is required for us to
provide Employers’ Liability cover. Where you have more than one PAYE Reference, please advise each one making it clear which company
they apply to):
If you do not have a PAYE Reference, please confirm that you are exempt and provide the reason below:
Are you a member of or accredited by any trade association or regulatory body? If so, please provide details below:
Do you operate to any recognised quality standards, eg. ISO 9001:2000? Yes
No
If Yes, please provide details below:
Please provide the following details of your current insurance:
Insurance Agent
Insurer
Expiry date
Premium
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COM237 Nov 2014
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Parent category: Business