Company Name:

Correspondence Address:

Legal Status:

Please Select    Limited Company Partnership Sole Trader *

HMRC Employer Reference Number (ERN):

Tel No:

Email:

Website:

Date company formed:

Director/Principal Name (1):

Director/Principal Name (2):

Date of birth:

Date of birth:

Occupation:

Occupation:

SIA No & Licence Type:

SIA No & Licence Type:

What is most important to you regarding the insurance you are looking to arrange?

Cover    Price    Service

When do you require the insurance to start from?

Please provide details of your experience and background in the security industry including names of companies you have worked for and positions held

Please provide details of your current insurer

Current Insurer:

Renewal Date:

Policy Number:

How many years have you held continuous insurance?

Please provide your Full Business Description including your activities to be covered under the insurance policy

Do your own contract conditions or your customer’s contract conditions increase your normal legal liabilities? (if yes a copy of the contract must be provided)

Yes No

Do you undertake or supply work:

Outside Great Britain

Yes No

In Northern Ireland

Yes No

At a height in excess of 16 meters

Yes No

On board ships, on off-shore installations, at airports, chemical or petrochemical works, nuclear Installations, bulk oil or gas storage facilities or within 5 meters of railway tracks

Yes No

At mainframe computer sites

Yes No

Do you engage Bona Fide subcontractors

Yes No

If yes do you check subcontractors hold public liability insurance and keep copies

Yes No

Has any insurer ever declined to insure you, cancelled or refused to renew your insurance

Yes No

Have you or any director or partner ever:

Been prosecuted under the Health & Safety at Work Act 1974, the Consumer Protection Act 1987 or any other legislation relating to the health & safety of your employees?

Yes No

Been convicted of or charged (but not yet tried) with a criminal offence other than a motoring offence?

Yes No

Been concerned with any business which has been wound up, liquidated, dissolved or ceased to trade?

Yes No

Been involved as an owner, director or partner of any other business in the last 5 years?

Yes No

Are all relevant employees licensed by the SIA?

Yes No

Do you vet in accordance with British Standards relevant to the security sector?

Yes No

If Yes, please tick which British Standard(s) you adopt

BS7499 (Guarding)
BS7858 (Screening)
BS7960 (Door supervisors)

Do you give any professional advices in return for a fee? (i.e. venue risk assesment)

Yes No

Do you have a system in place for ensuring guards/door supervisor & stewards are on duty on site at the required time?

Yes No

Do you provide any ancillary non-guarding activities such as industrial/commercial processes or monitoring machinery?

Yes No

Are you involved in crowd control, protestor sites, close protection, special event work or similar activities?

Yes No

If Yes please provide full details including nature of event and duties undertaken

Have you made any claims in the last 5 years?

Yes No

Number of Door Supervisors/Security Guards

Number of Clerical Employees

Public Liability

£1 milllion   £2 milllion   £5 milllion   £10 milllion  

Products Liability

£1 milllion   £2 milllion   £5 milllion   £10 milllion  

Employers Liability

£10 milllion  

Professional Indemnity

£100,000   £250,000   £500,000   £1 milllion  

Tick if a different limit is required for any of the above

Inefficacy

Property in your Care Custody and Control

Wrongful arrest

Deliberate acts

Loss of keys

Personal Accident

Fidelity Bonding

Guard Dog Handling

Member to Member Liability

Use of Restraints

Cash in Transit

Security Consultants (non manual activities only)

Private Investigation

Static & Mobile Security Guarding

Door Supervisors (Licensed Premises)

Security Training (General)

Security Training (Physical Intervention)

Music Event Security

Event Security (General)

Boxing Event Security

Trade Shows/Exhibition Security

Football Stadium Security

Traffic Management At Events

Close Protection Operatives (CPO) (UK Only)

CPO (UK & Europe Only)

CPO (W’wide Exc Hostile Countries & USA)

Private Residential Security

Totals

Please advise us of any material facts, other information or special requirements not already disclosed

Are you a member of:

Working the Doors
SIA Approved Contractors Scheme
British Security Industry Association

Do you also require a separate quotation for Office, Property Insurance, Group Personal Accident or Directors and Officers Insurance?

Yes No

Would you consider signing a 3 Year Long Tem Agreement to renew at quoted rates in return for a 5% discount?

Yes No

If you were happy to proceed with our quote,
how would you like to pay the insurance premium?

Please Select Cash Cheque Credit/Debit Card Direct Debit

Where did you hear about us?

Please Select Google Yahoo eCademy Workingthedoors.co.uk Closeprotectionworld.co.uk Security Industry Authority British Bodyguard Association British Security Industry Association Magazine advert Recommendation Direct Mail Other *