Tools, Equipment and Hired in Plant Enquiry Form

Name(s)*:

(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?*

Please state fully all activities in which you or your firm are involved:

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?

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:

Is cover required for Wood Chipping Machinery?

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?

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: