Tree Surgery and Forestry Enquiry Form

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

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?

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):

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?

Do you require this cover?

1. Name:

Date of Birth:

Occupation:

Sickness:

Benefit Required:

2. Name:

Date of Birth:

Occupation:

Sickness:

Benefit Required:

3. Name:

Date of Birth:

Occupation:

Sickness:

Benefit Required:

4. Name:

Date of Birth:

Occupation:

Sickness:

Benefit Required:

Please provide details of any illnesses, operations or bodily injuries (except childhood complaints) suffered by anyone to be covered