Name	A value is required.	- Choose - Mr Mrs Miss Dr	Company Name
No & Street		Postcode
Email Address	A value is required.Invalid format.	Telephone Number	A value is required.
Contract Price (£)		Date Cover/Quote Required from

Please provide details of the contract including the address, the type of property, contract length etc.

Sums Insured and Cover - the following sums insured and limits are standard under the contract, if you require other limits please specify the required limit.
Employers Liability - £10,000,000
Public Liability - £2,000,000
Value of Own Plant (including tools, equipment, and temporary buildings) - £20,000
Hired in Property? - £20,000
Additional Covers
Total Value of Employees' Tools to be Covered (Max Limit £500 any one employee):
Value of existing structures
General Information
Is there an appointed Safety Officer, or a person clearly responsible for Health & Safety Issues?	Yes No
Is the contract address in an exposed position to storm/flood (e.g. within 250 metres of sea front/watercourse?	Yes No
Are 100% of the premises and outbuildings being constructed from brick, stone, or concrete, with no combustible internal panels, and roofed with slates, tiles, concrete, metal or asbestos, and with no more than 25% of the total roof area being felt on timber?	Yes No
Will you occupy the residence upon completion?	Yes No
Please give details of all losses whether insured or otherwise that have occurred in the last 3 years. If "none" state none	None