Master Tradesman PlusProposal Form

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A Commencement Date of Insurance

Date insurance to start?

B Information About You and Your Business

1. Your full name including the names of all partners and any trading name

2. Your Business Address and Telephone Number

3. Your trade or business. (Please describe fully)

4. How many years experience do you have in the trade?

5. How many persons are involved in the primary trade activities of the business?Please state the number for each category. Maximum 6 in total.

Principals / Partners / Directors

Employees, Labour only sub-contractors, or those working under government schemes

C The Cover you require

1. Public Liability Indemnity Limit required. Please tick one box (This cover is compulsory under the policy).

(i) £1 Million (ii) £2 Million (iii) £5 Million

2. Employers’ Liability Yes No

(i) Is Employers’ Liability required?

(ii) Do you require the following extensions of cover to apply?

(a) Injury to Working PartnersThis extension includes any working principal or partner as an employee but only in respect of injury to the personfor which another partner or employee is legally liable.

(b) Employers’ Liability cover for employees using power driven woodworking machinery other than portable toolsapplied to the work by hand

If Yes, please state how many persons use such machineryPlease note that use of such machinery is excluded for all trades unless this extension is requested.

/ /

Postcode

Business Tel No. Mobile Tel No.

years

Master Tradesman Plus Proposal Form Important notes 1. Your Broker/Intermediary will supply you with a copy of the policy summary. Please

ensure you have read a copy of the policy summary prior to completing this form.

2. You should keep a record (including copies of letters) of all information provided tothe Company relating to this proposal, a copy of which will be provided on requestwithin a period of three months after its completion. A full specimen policy wordingis available on request.

Cover cannot apply until this proposal is accepted.The policy will be renewable annually on this date.

Policy No.

Agreement No.

Intermediary No.

Ref.

Please note that if you have less than 2 years experience in the tradethe general property damage excess on your policy will be doubledfor the first period of insurance.

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3. Tools Cover

Is tools cover required? Yes No If so, please state the Sum Insured limit: £1,250 £2,500 £5,000

Which level of cover is required? Standard Standard Plus

Cover is available for hand tools and hand held portable power tools used in connection with the business which are owned or hired in by You or anypartner or director working manually. Please refer to the policy summary for further information regarding sums insured and the difference betweenStandard and Standard Plus covers.

Please note this cover is not available for all trades. Please refer to your Broker/Intermediary for full details.

4. Goods In Transit (This cover is only available if Tools Cover is selected). Yes No

Is Goods In Transit cover required?

D Your business activities Yes No

1. Do your payments to bona-fide or supply and fix subcontractors exceed £50,000 per annum?

2. Do you undertake work away from your premises involving the use of

(i) Welding or Flame Cutting Equipment?

(ii) Any other equipment for the application of heat?

3. Do you hire out Plant and/or Machinery to other persons or firms?Please note that all Plant and Machinery whether hired out or not MUST be properly maintained, adequately guarded and regularly inspected to comply with statutory requirements.

IMPORTANT

If the answer to any of questions D1 to D3 is Yes you should give full details below, including the relevant turnover amounts andtypes of work undertaken and refer to your broker. (Please continue on a separate sheet if necessary).

4. Do you undertake work involving Yes No

(i) The installation, service, maintenance or repair of gas appliances, pipework, equipment or flues?

(ii) If Yes, are you Gas Safe Registered or will such work be undertaken solely by Gas Safe Registered persons?

Please note that if the answer to 4(ii) is No then this proposal is unacceptable and you should refer to your brokerfor alternative quotations.

5. For the trades of BUILDERS and PROPERTY MAINTENANCE / REPAIRERS only:- Yes No

(i) Do you undertake separate contracts for any of the following activities which exceed 15% of your annual turnoverin total? i.e. not incidental to your building and/or maintenance contracts (please tick where appropriate).

Painting and Decorating Roofing Groundworks Plumbing and Heating

(ii) Please tick any of the trades listed below that exceed 5% of your annual turnover as SEPARATE CONTRACTS (i.e. not incidental to your building and/or maintenance contracts).

Timber Treatment Damp Proofing Civil Engineering

6. For the trades of BUILDERS and BRICKLAYERS only:- Yes NoDo you undertake any external work at a height from the ground of more than 15 metres or any internal workat a height from the floor of more than 15 metres?

7. For the trade of BUILDERS only:-

Do you solely undertake work on private dwellings, shops, offices, hotels, public houses, guest houses, schools,colleges, residential, retirement or nursing homes of not more than four floors including basement and attic(including the grounds thereof)?

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E Your Insurance and Claims historyYes No

1. Has any Insurer cancelled, declined to provide or renew cover or imposed special terms in respect of the risksnow proposed?

2. Have you or any partner or director

(i) been convicted during the past 5 years of any offence relating to the Health and Safety of your employees or members of the public in connection with your business?

(ii) been convicted or is any prosecution pending for any offence involving dishonesty of any kind including for example arson, fraud, theft or handling stolen goods?

If you have answered Yes to either of these questions please give full details below. (Please continue on a separate sheet if necessary).

Yes No3. In respect of any of the risks proposed have you or any partner or director suffered any loss, made any claim or

been involved in incidents which could have resulted in a claim whether covered by insurance or not?

If you have answered Yes to this question please give details below including incident dates, full details and amounts.(Please continue on a separate sheet if necessary).

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F DeclarationIMPORTANTBefore signing the declaration, please check that you have completed this form in accordance with the cover you require and have answeredall the questions – thank you.

How We Use Your InformationThe personal information, provided by you, is collected by or on behalf of Covea Insurance plc and may be used by us, our employees, agentsand service providers acting under our instruction for the purposes of insurance administration, underwriting, claims handling and for research,or statistical purposes. We may also share your information with reinsurers and regulators, as required by law.

From time to time we may need to undertake some of the processing of your data in countries outside of the European Economic Area, and insuch cases we will ensure that there is an agreement in place which gives equivalent assurances as found in the Data Protection Act 1998.

We will not use your information or pass it on to any other person for the purposes of marketing further products or services to you.

We will collect sensitive information when dealing with your policy, we will however only collect information that is relevant to your policy, itsadministration or claims handling.

Your personal information will be kept secure at all times.

Fraud Prevention and detectionIn order to prevent or detect fraud we will check your details with various fraud prevention agencies, who may record a search. Searches mayalso be made against other insurers’ databases. If fraud is suspected, information will be shared with those insurers. Other users of the fraudprevention agencies may use this information in their own decision making processes. We may also conduct credit reference checks in certaincircumstances. You can find out further details explaining how the information held by fraud prevention agencies may be used or in whichcircumstances we conduct credit reference checks and how these checks might affect your credit rating by contacting Covea Insurance plc.

Disclosure of other people’s personal informationYou should show this notice to anyone whose personal information you provide to us. You must ensure that any such information you supplyrelating to anyone else is accurate and that you have obtained their consent to the use of their data for the purposes set out above.

Your RightsUnder the Data Protection Act 1998 you have the right of access to the personal information held about you by Covea Insurance plc.

You can exercise this right by contacting us. We will make a charge of £10 for dealing with these requests.

You have the right to request that we correct any inaccuracies in the personal information we hold about you. Please contact your insurancebroker, or Covea Insurance plc, if your personal information needs updating.

ConsentBy providing us with information, you also provide us with your consent and that of any other person whose information you provide to thepersonal information being used for the purposes set out above.

How to contact UsPlease visit www.coveainsurance.co.uk/dataprotection if you would like some more detailed information on how we share your personalinformation.

If you have any concerns about our use of your information please write to Customer Relations, Covea Insurance plc, Norman Place, Reading,Berkshire. RG1 8DA. If you contact Covea Insurance plc by telephone your call may be recorded for training and evidential purposes.

Choice of LawThe parties to an insurance contract are free to choose the law that will apply. Unless we agree in writing with you otherwise, this insuranceshall be subject to the law applying in the part of the United Kingdom, Channel Islands or Isle of Man where you have your principal place ofbusiness. If there is any dispute, the law of England and Wales shall apply.

Registration and Regulatory InformationCovea Insurance plc. Registered in England and Wales No. 613259. Registered office: Norman Place, Reading, Berkshire. RG1 8DA.

Covea Insurance plc is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the PrudentialRegulation Authority. Our Reference Firm Number is 202277. You can check this on the Financial Services Register by visiting the FCA’swebsite www.fca.org.uk/register or by contacting the FCA on 0800 111 6768.

Fair Presentation of the RiskYou have a duty to make a fair presentation of the risk when you first take out this policy and also whenever you renew it or ask us to changeyour cover. You should ensure that any information you have provided to us is accurate and complete. If you do not comply with your duty tomake a fair presentation of the risk, your policy may not be valid or the policy may not cover you fully or at all. If you are not sure whether certain facts are relevant please ask your insurance broker. You must check all the information contained within this document immediately and tell us if any details are incorrect. You should keep awritten record (including copies of letters) of any information you give us or your insurance broker.

Proposer’s Signature Date

Please make sure you have signed and dated this form.

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Cover No. Premium Total Premium

Public Liability Total number of persons = £

Employers’ Liability Employees and Directors @ £ each = £

Tools Cover Principals, Partners or Directors @ £ each = £

Deletion of fixed woodworking Persons who use woodworking machinery @ £ each = £machinery exclusion

Injury to Working Partners Principals @ £ each = £

Goods in Transit = £

Total Premium = £

+ IPT = £

Total Premium + IPT = £

G Premium Calculation for completion by Broker

Covéa InsuranceNorman PlaceReadingRG1 8DATelephone: 0844 902 1000Fax: 0118 955 2211

www.coveainsurance.co.uk

Covea Insurance plcRegistered Office: Norman Place, Reading, Berkshire RG1 8DARegistered in England and Wales No. 613259Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority No. 202277

L21Z 08/16

Covéa InsuranceNorman PlaceReadingRG1 8DATelephone: 0330 221 0444Fax: 0118 955 2211

www.coveainsurance.co.uk