Recruitment Start-up Agency Proposal Form

Your Business

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Company Name

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Main Office Address

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Subsidiary Companies

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Date Business Established

Date

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Employment Reference Number (ERN)

Your Business Activities

Please confirm the following:

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Your estimated turnover per annum is less than £200,001

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You only place permanent staff or Temporary Workers carrying out clerical, medical/care or light manual tasks

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All Temporary Workers placed out by you will be under a Contract For Services, and NOT employed by you under a Contract of Employment.

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All Temporary Workers will be placed out under your own Standard Terms of Business which make the hiring company responsible for those Temporary Workers whilst they are placed with them.

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You are based in the UK only with no representation outside of the UK.

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Your turnover will be generated from placement in the UK and Europe only

Please confirm the percentage split for the type of placements:

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Permanent Placements

Temporary workers placed in the following roles

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Clerical Professionals

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Professional Medical and Care workers

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Light Manual including Retail, Warehouse, and Manufacturing

Please equate the total to 100%

Claims History and Declaration

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Has any claim, whether successful or not been made against you, your predecessors in business, or any past or present partner or director or Employee (whether previously insured or not)?

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Are you, or any of the partners, directors or Employees AFTER FULL ENQUIRY aware of any circumstance which may give rise to a claim against you, your predecessors in business or any past or present partner, director or Employee?

Package Cover Choice

Please select your preferred level of cover from the following:

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Your Choice

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Limit of Indemnity Level 1

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Limit of Indemnity Level 2

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Limit of Indemnity Level 3

If you require alternative limits of indemnity to the ones specified above, just leave all choices as “?” and let us know the limits you require. We will then provide you with a quotation based on those limits.

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General Declaration (Required.)

I/We declare that any information or statements made in this proposal form is accurate and complete to the best of My/Our knowledge and belief.

I/We acknowledge that the details provided in this proposal form will form part of the contract of insurance with the Insurers.

Recruitment Start-up Agency Proposal Form

Question Title

* Company Name

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* Main Office Address

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* Subsidiary Companies

Question Title

* Date Business Established

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* Employment Reference Number (ERN)

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* Your estimated turnover per annum is less than £200,001

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* You only place permanent staff or Temporary Workers carrying out clerical, medical/care or light manual tasks

Question Title

* All Temporary Workers placed out by you will be under a Contract For Services, and NOT employed by you under a Contract of Employment.

Question Title

* All Temporary Workers will be placed out under your own Standard Terms of Business which make the hiring company responsible for those Temporary Workers whilst they are placed with them.

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* You are based in the UK only with no representation outside of the UK.

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* Your turnover will be generated from placement in the UK and Europe only

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* Permanent Placements

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* Clerical Professionals

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* Professional Medical and Care workers

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* Light Manual including Retail, Warehouse, and Manufacturing

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* Has any claim, whether successful or not been made against you, your predecessors in business, or any past or present partner or director or Employee (whether previously insured or not)?

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* Are you, or any of the partners, directors or Employees AFTER FULL ENQUIRY aware of any circumstance which may give rise to a claim against you, your predecessors in business or any past or present partner, director or Employee?

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* Limit of Indemnity Level 1

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* Limit of Indemnity Level 2

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* Limit of Indemnity Level 3

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* General Declaration (Required.)

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* Name (Required.)

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* Position (Required.)

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* Email (Required.)

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* Signature (Required.)

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* Date (Required.)

Company Name

Main Office Address

Subsidiary Companies

Date Business Established

Employment Reference Number (ERN)

Your estimated turnover per annum is less than £200,001

You only place permanent staff or Temporary Workers carrying out clerical, medical/care or light manual tasks

All Temporary Workers placed out by you will be under a Contract For Services, and NOT employed by you under a Contract of Employment.

All Temporary Workers will be placed out under your own Standard Terms of Business which make the hiring company responsible for those Temporary Workers whilst they are placed with them.

You are based in the UK only with no representation outside of the UK.

Your turnover will be generated from placement in the UK and Europe only

Permanent Placements

Clerical Professionals

Professional Medical and Care workers

Light Manual including Retail, Warehouse, and Manufacturing

Has any claim, whether successful or not been made against you, your predecessors in business, or any past or present partner or director or Employee (whether previously insured or not)?

Are you, or any of the partners, directors or Employees AFTER FULL ENQUIRY aware of any circumstance which may give rise to a claim against you, your predecessors in business or any past or present partner, director or Employee?

Limit of Indemnity Level 1

Limit of Indemnity Level 2

Limit of Indemnity Level 3

General Declaration (Required.)

Name (Required.)

Position (Required.)

Email (Required.)

Signature (Required.)

Date (Required.)