Print this form and fax to 01604 615407 or email to carl.tero@insurance-world.co.uk
TATTOOIST LIABILITY PROPOSAL FORM

Please complete all details in BLOCK LETTERS. Insurance will not be in force until Underwriters accept the proposal form.

Proposer’s Full Name
..........................................................................................................................................................................................................................................

Trading Name (If different from above)
.......................................................................................................................................................


Postal Address

.............................................................................…............................................................................................................................Postcode……………….
Occupation / Business / Trade

..............................................................................………………………………..…………………………………..……………………………………………………………

Address of premises to be insured
(if different from postal address)

...........................................................................................................................................................................................................Postcode........................
Date the Company was established

…………………………………………………..…

Date from which insurance is required

........................................................................

Please state the coverage required: Limit of Indemnity required:

EMPLOYERS LIABILITY (not available on a stand alone basis) £10,000,000

PUBLIC LIABILITY (£1, £2 OR £5 MILLION) £ ……………

Are you a member of a Trade Association? ………………………. YES/NO If YES, please state the name
Do you comply with the Association’s working code of practice? …. YES/NO
Do you have a standard contract between you and your client to which you comply? ….… YES/NO

Is your premises in a good state of repair and is your equipment at your own premises and all contract sites locked away or secured when not in use and otherwise in good order and condition? ………….. YES/NO

Are all your employees contracts entered into in the United Kingdom? ………YES/NO If NO, state number and nationality of foreign employees

Do you work outside of the UK? …………………. YES/NO If YES, please provide details and state territories involved


Please complete the following details:
Annual Wageroll : £
Annual Turnover : £

Please provide details of any claims in the last 5 years;-

Please state name of present and previous insurers over the last 3 years

Has any Insurer ever cancelled your policy, increased your premium or imposed special conditions or restrictions mid-term? …….YES/NO If YES, please provide details

IMPORTANT NOTICE. TO BE COMPLETED IN ALL CASES.

Failure to disclose material facts could result in your policy being invalidated. Material facts are those facts which might influence the acceptance or assessment of your proposal. If you are in any doubt as to whether a fact is material you should disclose it.
I/WE hereby declare that to the best of my/our knowledge all the statements given on this Proposal Form are true and complete and that I/we have disclosed all material facts that need to be provided to the Underwriters.
I/WE undertake to exercise all ordinary and reasonable precautions for the safety of the insured property.
I/WE hereby agree that this Proposal and this Declaration shall be the basis of the contract of the insurance between the Insurers and Myself/Ourselves.

Name ..................................................................... Position ....................................................

Signature .................................................................Date…........................................................

Note: Law Applicable to Contract: If the proposer shown on this Proposal Form is a private individual or a sole trader then they are free to choose the law applicable to this Insurance Contract. This Contract will be subject to English Law (or Scottish Law where applicable)

Note: If you are registered for VAT any claim for loss or damage to property will be paid exclusive of VAT, and you are advised to arrange your sums insured accordingly. Allowance should be made to include an amount for VAT in the sum insured if you are not registered.