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Insurance Services
Name*:
(State names of all partners and trading name if not a limited company)
Address Line 1*:
Address Line 2:
Address Line 3:
Postcode*:
Telephone Number*:
Fax Number:
Email Address*:
Web Address:
Current/Previous Insurer or Broker Name:
Renewal Date:
Renewal/Target Premium:
How did you hear about Lycetts?*
How many years experience do you have in this industry?
Please state fully all activities in which you or your firm are involved:
1. Make, Model & Description
Serial Number
Year of Make*
Estimated Second Hand Value*
Replacement Cost as New*
This policy does not give Road Risks cover. Is this cover required?
This policy does not cover any plant hired in. Is this cover required?
This policy does not cover plant hired out by you. Is this cover required?
If you have answered yes to any of the above questions, please provide details below
Have there been any incidents in the last 5 years, which have, or could have given rise to any claims under this section? If so, please provide details below
Date of Incident:
Incident Description:
Amount Paid/Reserve:
