Combined Liability (Quote)

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Combined Liability (Quote)
Contractors All Risks - above £3m (Quote)
Contractors All Risks – up to £3m (Quote)
Cyber (Quote & Bind)
Directors and Officers (Quote & Bind)
Excess Layer (Quote & Bind)
Food and Drink Product Recall (Quote)
Marine Cargo (Quote)
Yachts & Boats (Quote)

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For information on how we use your personal data please refer to our Privacy Notice.

Please note that minimum premiums are £1,000 plus IPT for EL and £1,000 plus IPT for PL.

Agent Details

Instructions to NFU Mutual Agent; please complete the following details:

NFU Mutual Agency Code
*

NFU Mutual Agent Name
*

Please enter name

NFU Mutual Email Address
*

Please enter your email Please enter a valid Email Address

NFU Mutual Telephone
*

Please enter a Telephone Number Please enter a valid phone number

Client Payment Method
*

Please select a payment method

Type of Business
*

Transfer existing NFUM cover to NIS

Existing NFUM Client; New cover to NIS

New to NFUM; New to NIS

Existing NIS Renewal

Please select

iFaces Ref
*

Please enter

Important Notice– Please ensure your clients are informed and understand the information below.

In seeking a quotation and/or binding cover via this portal you are agreeing that you will have served the client all relevant regulatory documents.

Fair Representation of the Risk

The information provided here must make a fair presentation of the risk, in accordance with Section 3 of the Insurance Act 2015.
To Summarise, you must:
a) Tell us about every material circumstance which you know or ought to know. Failing that, you must give us sufficient information to make us aware that we need to make further enquiries in order to reveal material circumstances. Information is material if it would influence the judgement of a prudent insurer as to whether to accept the risk, or the terms of the insurance (including premium);
b) Disclose information in a reasonably clear and accessible way; and
c) Ensure that every material representation of fact is substantially correct, and that every material representation of expectation or belief is made in good faith.

For the purposes of the above, you are expected to know the following:
a) If you are an individual, what is known to the individual and anybody who is responsible for arranging his or her insurance.
b) If you are not an individual, what is known to anybody who is part of your senior management; or anybody who is responsible for arranging your insurance.
c) Whether you are an individual or not, what should reasonably have been revealed by a reasonable search of information available to you. The information may be held within your organisation, or by any third party (including but not limited to subsidiaries, affiliates, the broker, or any other person who will be covered under the insurance). If you are insuring subsidiaries, affiliates or other parties, we expect that the Insured will have included them in its enquiries, and that you will inform us if you have not done so. The reasonable search may be conducted by making enquiries or by any other means.

Completion of this form is required by us as part of your duty of fair presentation.

Insurers may cancel cover and/or refuse to pay any claims if the facts provided in this form are incorrect.

Arthur J. Gallagher Insurance Brokers Limited, Arthur J. Gallagher (UK) Limited and their affiliates and subsidiaries "we" or "us" or "Gallagher" collect and process data about individuals. We are insurance intermediaries and part of the Arthur J. Gallagher global group of companies. The Gallagher group company which provides the insurance intermediary service offered to you is primarily responsible for the personal data collected in relation to that service. Information on the Gallagher group companies and their services is available here . We collect and process information about you in order to arrange insurance policies and to process claims. Your information is also used for business purposes such as fraud prevention and detection and financial management. This may involve sharing your information with third parties such as insurers, reinsurers, other brokers, claims handlers, loss adjusters, credit reference agencies, service providers, professional advisors, our regulators, police and government agencies or fraud prevention agencies. We may record telephone calls to help us monitor and improve the service we provide. For further information on how your information is used and your rights in relation to your information please see our privacy notice at https://www.ajginternational.com/Privacy-Policy/. If you are providing personal data of another individual to us, you must tell them you are providing their information to us and show them a copy of this notice.

Client Information

Proposer & Legal Trading Name

A business must have a legally recognised title and identity to enter into a contract. This can include the legal registered name of the business as well as any trading names which they might use.

Please enter

Postal Address

Please enter the post code, or part of the address, or the company name, and then pick the correct entry from the list provided.

Address search

Full Business Description

A description of the activities in which the business engages and the nature and type of goods, products or services sold, received, supplied, installed or available.

Please enter a description

What year was the business established
*

Please Enter Year Please enter valid year

Current Insurer

If the proposer has less than 3 years’ experience in the trade or profession, then please provide details/evidence of appropriate experience in the trade or management of the trade

Current premium.

Please note that minimum premiums are £1,000 plus IPT for EL and £1,000 plus IPT for PL.

Please select a valid currency amount

Inception Date Required
*

Company Website

Customer History Details

Have you, or to your knowledge, any person directly connected with the ownership or management of the business or any other person to whom cover is to apply ever been

Refused insurance, had insurance cancelled or declared void (as though it never existed) or had renewal declined or any special terms or conditions imposed? *

Yes

If Yes to the above, please give details

Please enter details

Subject to any form of bankruptcy proceedings (whether discharged or not)
*

Yes

If Yes to the above, please give details

Subject to any court judegements in the last five years *

Yes

If Yes to the above, please give details

Please enter details

A director of a company which went into Liquidation or put into Administration with Creditors under statue or with the last five years been subject to one or more court judgements *

Yes

If Yes to the above, please give details

The subject of a disqualification order made by a court under the Company Directors Disqualification Act?
*

Yes

If Yes to the above, please give details

Convicted of any non motoring criminal offence, or do you have any prosecutions pending? *

Yes

If Yes to the above, please give details

Prosecuted for breach of any statutory requirements relating to health and safety? *

Yes

If Yes to the above, please give details
*

Insurance History

During the past five years, in respect if the cover proposed, have you made a claim, suffered an uninsured loss or had a claim made against you?
*

Yes

For policies with more than 5 claims in 5 years or claims totalling over a £100k please send directly to the NIS team and do NOT submit via this portal.

For policies with more than 5 claims in 5 years or claims totalling over a £100k please send directly to the NIS team and do NOT submit via this portal.

If 'Yes' to the above, give details Date

Claim Type *

Other

Current Claim Position *

Details
*

Paid Out
*

Please select a valid currency amount

Reserve
*

Please select a valid currency amount

Total
*

Please select a valid currency amount

Any other Claim?
*

Yes

Date

Claim Type
*

Other

Current Claim Position
*

Details
*

Paid Out
*

Please select a valid currency amount

Reserve *

Please select a valid currency amount

Total
*

Please select a valid currency amount

Any other Claim?
*

Yes

Date
*

Claim Type
*

Other

Current Claim Position *

Details
*

Paid Out
*

Please select a valid currency amount

Reserve
*

Please select a valid currency amount

Total
*

Please select a valid currency amount

Any other Claim?
*

Yes

Date
*

Claim Type
*

Other

Current Claim Position
*

Details
*

Paid Out
*

Please select a valid currency amount

Reserve
*

Please select a valid currency amount

Total
*

Please select a valid currency amount

Any other Claim?
*

Yes

Date
*

Claim Type
*

Other

Current Claim Position *

Details
*

Paid Out
*

Please select a valid currency amount

Reserve
*

Please select a valid currency amount

Total

Please select a valid currency amount

Any other Claim?
*

Yes

Date
*

Claim Type
*

Other

Current Claim Position *

Details
*

Paid Out
*

Please select a valid currency amount

Reserve

Please select a valid currency amount

Total

Please select a valid currency amount

Are you aware of any cicumstances that could give rise to a claim against you or the company?
*

Yes

If 'Yes' give details

Public & Products Liability

Do you require Public & Products Liability?
*

Public & Products Liability Limit of Indemnity required

Other

Turnover for the forthcoming insurance year

UK
*

Please select a valid currency amount

EU
*

Please select a valid currency amount

USA/Canada
*

Please select a valid currency amount

Rest of the World *

Please select a valid currency amount

Total

Please select a valid currency amount

Please provide a full breakdown of the business description including the percentage (%) split of activities by turnover (see info button)

For Example, if the insured is a Landscape gardener who also carries out tree felling along with gutter clearing, you should display their total turnover split as the following

 Landscape Gardeners– 80%
 Tree Felling - 15%
 Guttering- 5%

What percentage (%) of the total turnover relates to work away from your premises involving use of heat

Please enter positive numbers

If you do undertake heat work away from the premise, please advise the type of heat work

What percentage (%) of the total turnover relates to work above 15m in height

Please enter positive numbers

What is the maximum height you work to

*

Please enter positive numbers

What percentage (%) of the total turnover relates to work below 3m in depth

Please enter positive numbers

What is the maximum depth you work to

Please enter positive numbers

What percentage (%) of the total turnover relates to offshore work

Please enter positive numbers

What percentage (%) of the total turnover relates to work involving woodworking machinery

Please enter positive numbers

Employers Liability

Do you require Employers Liability Cover
*

Employers Liability Limit of Indemnity required

Other

Do you employ directly or indirectly more than 10 persons?
*

Yes

No of Employees (Estimated)

Clerical
*

Please enter positive numbers

Manual
*

Please enter positive numbers

Labour only subcontractors
*

Please enter positive numbers

Bona-fide Subcontractors
*

Please enter positive numbers

 For all other Occupations,please specify below

Does the client have any additional occupations? If Yes, please specify below

Yes

Occupation

Please complete additional occupations wageroll sections for any additional occupations inserted above regarding number of employees.

Additional occupation number of employees

Please select a valid currency amount

Does the client have any further additional occupations? If Yes, please specify below

Yes

Occupation
*

Additional occupation number of employees
*

Please select a valid currency amount

Does the client have any further additional occupations? If Yes, please specify below
*

Yes

Occupation
*

Additional occupation number of employees
*

Please select a valid currency amount

Does the client have any further additional occupations? If Yes, please specify below
*

Yes

Occupation
*

Additional occupation number of employees
*

Please select a valid currency amount

Does the client have any further additional occupations? If Yes, please specify below *

Yes

Occupation
*

Additional occupation number of employees
*

Please select a valid currency amount

Total number of employees
*

Please enter positive numbers

Wageroll for Persons undertaking work at your premises for the forthcoming insurance year

Clerical *

Please select a valid currency amount

Manual *

Please select a valid currency amount

Labour only subcontractors
*

Please select a valid currency amount

Bona-fide Subcontractors

Please select a valid currency amount

Additional Occupation (please complete if details have been provided for additional occupations above)

Yes

Occupation

Please complete additional occupations wageroll sections for any additional occupations inserted above regarding number of employees.

Wageroll for additional occupation

Please select a valid currency amount

And for any subsequent occupations added if Yes is ticked

Yes

Occupation
*

Wageroll for additional occupation
*

Please select a valid currency amount

And for any subsequent occupations added if Yes is ticked
*

Yes

Occupation
*

Wageroll for additional occupation
*

Please select a valid currency amount

And for any subsequent occupations added if Yes is ticked
*

Yes

Occupation
*

Wageroll for additional occupation
*

Please select a valid currency amount

And for any subsequent occupations added if Yes is ticked
*

Yes

Occupation
*

Wageroll for additional occupation
*

Please select a valid currency amount

Total Wageroll for work at premises

Please select a valid currency amount

Wageroll for Persons undertaking work away from your premises for the forthcoming insurance year

Clerical
*

Please select a valid currency amount

Manual
*

Please select a valid currency amount

Labour only subcontractors *

Please select a valid currency amount

Bonafide-Subcontractors

Please select a valid currency amount

Additional Occupation (please complete if details have been provided for additional occupations above)

Yes

Occupation

Please complete additional occupations wageroll sections for any additional occupations inserted above regarding number of employees.

Wageroll for additional occupation

Please select a valid currency amount

And for any subsequent occupations added if Yes is ticked

Yes

Occupation
*

Wageroll for additional occupation
*

Please select a valid currency amount

And for any subsequent occupations added if Yes is ticked
*

Yes

Occupation
*

Wageroll for additional occupation
*

Please select a valid currency amount

And for any subsequent occupations added if Yes is ticked
*

Yes

Occupation
*

Wageroll for additional occupation
*

Please select a valid currency amount

And for any subsequent occupations added if Yes is ticked
*

Yes

occupations
*

Wageroll for additional occupation
*

Please select a valid currency amount

Total wageroll for work away from premises

Please select a valid currency amount

MANUAL WORK DETAILS

Please specify detail below as a percentage of total wages/earnings

For manual work, how much of the total wages/earnings, declared above relates to work involving use of heat

Please enter a valid percentage Please enter a valid percentage

For manual work, how much of the total wages/earnings, declared above relates to work above 15m in height

Please enter a valid percentage Please enter a valid percentage

For manual work, how much of the total wages/earning, declated above relates to work below 3m in depth

Please enter a valid percentage Please enter a valid percentage

For manual work, how much of the total wages/earnings, declared above relates to overseas work

Please enter a valid percentage Please enter a valid percentage

For manual work, how much of the total wages/earnings, declared above relates to offshore work

Please enter a valid percentage Please enter a valid percentage

For manual work, how much of the total wages/earnings, declared above relates to work involving woodworking machinery

Please enter a valid percentage Please enter a valid percentage

Hazardous Work

Do you carry out work on or in any of the following locations: Towers, Steeples, Spires, Chimney Shafts, Blast Furnaces, Dams, Canals, Viaducts, Bridges, Tunnels, Aircraft, Airports, Railways, Ships, Vessels, Air Cushioned Vehicles, Watercraft, Docks, Piers, Jetties, Wharves, Breakwaterss or Sea Walls, Collieries, Mines, Quarries, Chemical Works, Gas Works, Oil Refineries, Power Stations, Nuclear Installations or Establishments. If so please provide details below.
*

Important Information

Please read the following carefully:

The questions on this Proposal Form and any other details we specifically request, relate to facts which we consider material to underwriting this insurance. However, because no list of questions can be exhaustive, please consider whether there is any other material information which is known to you which could influence our assessment and acceptance of the risk.
FAILURE TO DISCLOSE MATERIAL FACTS WHETHER OR NOT THE SUBJECT OF SPECIFIC QUESTIONS MAY INVALIDATE YOUR INSURANCE
We recommend that you keep a record, including copies of this proposal, any letters and all information supplied to us for the purpose of entering into this insurance.

ADDITIONAL INFORMATION
Use this space to provide full details if there is any other material information which you should disclose:

Agents of the proposer must be aware that the provision of false or inaccurate information may invalidate your Client’s insurance and you accept and understand that Arthur J. Gallagher shall not be liable for any loss, damage or costs incurred arising as a result of your inputting false or inaccurate information in relation to your Client’s risk details onto this website in order to obtain a policy for your Client.

By ticking this box you are confirming that the proposer has an existing business relationship as a client of NFU Mutual. If you have any queries or wish to discuss any exceptions please contact NIS on 01789 455009 or email us on Mutual_Marketplace@nfumutual.co.uk

Please ensure you tick this box if you agree to the condition.

WhatHappensNextQuote

You can opt out of marketing communications at any time by contacting us: UK.unsubscribe@ajg.com

When this Submit button is engaged the following will happen.

The enquiry will be forwarded to Arthur J. Gallagher with a copy to NIS.
You will receive an email acknowledging that the enquiry has been successfully sent.
You will receive a response to the enquiry within 3 working days.
If terms are offered and acceptable please process the instruction using the SONIC system.
If there are further queries or issues to discuss please use the ‘Ask the Expert’ facility to communicate them.

Our team of insurance specialists are here to help. Please fill out the form below and we will get back to you.

Your Details

NFU Mutual Agency Code *

NFU Mutual Agent Name
*

NFU Mutual Email Address *

Please enter a valid Email Address

NFU Mutual Telephone *

Please enter a Telephone Number Please enter a valid phone number

Enquiry Details

Nature of enquiry *

Please provide full details relating to the enquiry you wish to make. This will ensure the issue is raised with the correct department as quickly as possible. If necessary the person dealing with it will telephone you to discuss the matter but, for audit purposes, the response will need to be in writing.

WhatHappensNextAskExpert

You can opt out of marketing communications at any time by contacting us: UK.unsubscribe@ajg.com

This form will now be sent to National Intermediary Services team who will respond or escalate dependent upon the nature of the enquiry. They will look to respond to you within a period of 1 working day to either provide an answer or explain to whom the enquiry has been directed and the expected timeframe for resolution.

In the event that you are unable to get the assistance you require, you can call NIS on 01789 455009.

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Arthur J. Gallagher is a trading name of Arthur J. Gallagher Insurance Brokers Limited, registered office: Spectrum Building, 7th Floor, 55 Blythswood Street, Glasgow, G2 7AT. Registered in Scotland. Company Number: SC108909. Authorised and regulated by the Financial Conduct Authority (Firm Reference Number: 311786).www.ajginternational.com

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