Commercial General Liability

1. Do you require a Quotation for:-









2. Date Business commenced:









If YES please supply a copy
3. Do you have a written Health & Safety Policy?


If YES please supply a copy









4. Are your premises in good state of repair, and are your ways, plant and machinery (at your own premises and all contract sites) properly fenced and guarded and otherwise in good order and condition?


5. Do you undertake design work for






6. Are all your employees contracts entered into in the United Arab Emirates?


If YES please supply a copy
7. Are any of the following used in connection with your business?

































8. Are you involved in any form of railway work?


9. Do you discharge any hazardous waste products (e.g. chemicals, gases, radioactive substances, dust, fumes or vapours) into the atmosphere, sewers, waterways or elsewhere?


If YES please advise type of waste and give full details of:
10. Do you carry out any manual work away from your own premises including outside of the UAE?


11. Do you design, give advice or prepare specification?


12. Do you supply any products that you do not manufacture?


If YES, do you







13. Give details of any products used:-





14. Are any of your products, currently or any in the past 3 years supplied directly or to your knowledge indirectly to the USA or Canada ?


15. Are any of the goods known to be potentially harmful to health or require any hazard warning?


16. Do you have any representation outside of the UAE?


Description Estimated No of Employees Estimated Annual Payments
Work at your premises Away from your premises
Current Est / Act Next Year Est / Act Current Est / Act Next Year Est / Act
Clerical
All other Employees (Please specify what type i.e. roofers, scaffolders, etc)
Labour Gangers, Labour only sub-contractors & self employed sub-contractors supplying Labour only
Proposers own annual remuneration if working manually in the Business
Woodworking machinists / carpenters
Bona Fide Sub-Contractors (No EL cover)

TURNOVER
UAE
Rest of the World
USA/Canada Exports
Total Turnover
18. Have you had any claims made against you during the under noted period?


(If YES please give details)
Employers Liability
Year Total Wages Deductible Settled Claims Reserves for Outstanding Claims
No. Amount No. Amount
1997
1998
1999
2000
2001
2002
2003
Total


Public Liability / Products
Year Total Wages Deductible Settled Claims Reserves for Outstanding Claims
No. Amount No. Amount
1997
1998
1999
2000
2001
2002
2003
Total
19. Please state name of present and previous insurers over the last three years




ALL CONTRACTORS MUST COMPLETE ‘CONTRACTORS ADDITIONAL PAGE’
TO BE COMPLETED IN ALL CASES
IMPORTANT NOTICE

Failure to disclose material facts could result in your policy being invalidated. Material facts are those facts which might influence the acceptance or assessment of your proposal. If you are in any doubt as to whether a fact is material you should disclose it.

I/WE hereby declare that to the best of my/our knowledge all the statements given on this Proposal Form are true and complete and that I/we have disclosed all material facts that ought to be communicated to the Underwriters.

II/WE undertake to exercise all ordinary and reasonable precautions for the safety of the insured property.

I/WE hereby agree that this Proposal and this Declaration shall be the basis of the contract of the insurance between the Insurers and Myself/Ourselves.





Law Applicable to Contract : If the proposer shown on this Proposal Form is a private individual or a sole trader then they are free to choose the law applicable to this Insurance Contract. This Contract will be subject to English Law (or Scottish Law where applicable)

CONTRACTORS ADDITIONAL PAGE

Year Nature CONTRACT VALUE

Do you undertake any work in connection with the following:-