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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:
What limit(s) of Indemnity do you require?
Please provide estimates of annual turnover split as follows:
Category
Estimated Turnover
Forestry Felling – Chainsaw
Forestry Felling – Mechanised
Tree Surgery – Chainsaw
Tree Surgery – Non-Chainsaw
All Other Turnover
Description of All Other Turnover
Do you use Bona Fide Sub-contractors?
If yes, please provide a description of the work they carry out and advise the annual payments made to them
Is any work undertaken for Railways?
Is any Powerline clearance undertaken?
Is any work undertaken outside the UK?
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:
Do you require this cover?
Please provide estimates of annual wageroll split as follows:
(Please include Directors/Principals drawings if a Limited Company)
Clerical Wageroll
Forestry Felling – Chainsaw Wageroll
Forestry Felling – Mechanised Wageroll
Tree Surgery – Chainsaw Wageroll
Tree Surgery – Non-Chainsaw Wageroll
All Other Wageroll
Description of All Other Wageroll
What limit of Indemnity do you require?
What is your estimated annual fee income for consultancy and advice?
Please categorise business activities and indicate the approximate percentage of gross income/fees these represent:
Consultancy work relating to the structural integrity of property and the possibility of subsidence and heave*
Tree hazard evaluation*
Other (please describe below)
Other Description
What ‘Retroactive Date’ is required and has cover been continuous from this date?
Date (DD/MM/YYYY):
Please confirm the full postal address where the Equipment is kept overnight:
Is all equipment including Wood Chipping Machines kept in a self contained, locked building of standard construction (brick or stone) accessed solely by you?
If no, please provide details
Are there any additional security features to the premises, e.g. alarm, security lighting?
Is cover required for Wood Chipping Machinery?
If yes, please detail below and answer the following questions:
Description Including Model:
New for old or market value?:
Insured Value (inc VAT if NOT registered):
Fitted with operational tracking system?
Please state the total new replacement value of your remaining equipment
Do you require this cover for plant and equipment hired in under contract?
What is the estimated annual amount paid in hire charges?
What is the maximum Single Article Limit of any one item hired in?
1. Name:
Date of Birth:
Occupation:
Sickness:
Benefit Required:
2. Name:
3. Name:
4. Name:
Please provide details of any illnesses, operations or bodily injuries (except childhood complaints) suffered by anyone to be covered