Confirmation of Insurance

Company Name *

Company Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Company Registration Number *

Employers Liability

Insurer *

Poilcy number *

Cover Period Start Date *

Cover Period End Date *

Indemnity limit £ *

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

Public Liability

Insurer *

Policy number *

Cover Period Start Date *

Cover Period End Date *

Indemnity limit £ *

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

Products Liability

Insurer *

Poilcy number *

Cover Period Start Date *

Cover Period End Date *

Indemnity limit £ *

Professional Indemnity

Insurer *

Poilcy number *

Cover Period Start Date *

Cover Period End Date *

Indemnity limit £ *

Trade Description *

Contract Works

Insurer *

Poilcy number *

Cover Period Start Date *

Cover Period End Date *

Indemnity limit £ *

File Upload (Please upload evidence of insurance) *

Click or drag a file to this area to upload.

Confirmation of Insurance