Confirmation of Insurance

Company Name *

Contact email *

You will be sent an automated reminder approx 2 week before you insurance expires

Company Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Company Registration Number *

Public Liability

Public Liability – Insurer *

Public Liability – Policy number *

Public Liability – Cover Period Start Date *

Public Liability – Cover Period End Date *

Public Liability – Indemnity limit £ *

Public Liability – Indemnity to principals extension e.g. West One Uk Ltd *

Employers Liability – Employers Liability

Employers Liability – Insurer

Employers Liability – Poilcy number

Employers Liability – Cover Period Start Date

Employers Liability – Cover Period End Date

Employers Liability – Indemnity to principals extension e.g. West One Uk Ltd

Employers Liability – Indemnity limit £

Products Liability

Products Liability – Insurer

Products Liability – Poilcy number

Products Liability – Cover Period Start Date

Products Liability – Cover Period End Date

Products Liability – Indemnity limit £

Professional Indemnity

Professional Indemnity – Insurer

Professional Indemnity – Poilcy number

Professional Indemnity – Cover Period Start Date

Professional Indemnity – Cover Period End Date

Professional Indemnity – Indemnity limit £

Professional Indemnity – Trade Description

Contract Works

Contract Works – Insurer

Contract Works – Poilcy number

Contract Works – Cover Period Start Date

Contract Works – Cover Period End Date

Contract Works – Indemnity limit £

File Upload (Please upload evidence of insurance) *

Click or drag a file to this area to upload.

Confirmation of Insurance