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Recruitment Agency Proposal Form

Your Business

Company Name
Main Office Address
Subsidiary Companies
Date Business Established
Date
Employment Reference Number(s)
Please provide us with a list of Company name(s) (including any Subsidiary companies) and corresponding Employment Reference Numbers below.
Your Business Activities
Please confirm:
Do you deal with the placement of permanent staff?
Do you supply Temporary Workers under a Contracts for Services?
Do you supply temporary Self-Employed or Personal Service Companies (PSC)?
Other business activities, not mentioned above (Please provide details below)
Please confirm details
Do you place your own Employed staff out on temporary contracts?
Please provide your average percentage fee you achieve on the placement of Temporary workers (e.g. 10%-15%)
If you sign Hirer’s Contract Terms (Non-Standard Contracts), what percentage of your turnover is generated from these contracts?
Territories
Please provide a percentage breakdown of turnover generated in the following territories:
Professional Indemnity Cover
Please select your required Professional Indemnity Limit of Indemnity
Please confirm your total turnover during your last completed financial year
Please confirm your estimated turnover for your next financial Year
Do you sign Hirers Contracts where you are required to cover the negligent acts errors and omission of the Temporary Workers (Vicarious Liability)?
Do you require cover for the Dishonesty of Temporary Workers you place?
Please let us know the Retroactive Date on your current policy
Date
Combined Liability
The limit of indemnity for Employers Liability will be £10,000,000.

Please select your required Public Liability
Please confirm the percentage split for the type of Temporary Workers Placed:
Drivers Negligence
Any One Claim:
Total amount of Claims during Any One Period of insurance:
What percentage of the drivers you supply require Drivers’ Negligence insurance:
Directors and Officers
If you require cover for Director and Officers, please confirm the limits and covers you require:
Directors and Officers limit of indemnity:
Company Reimbursement / Entity Cover Limit of Indemnity:
Employment Practices Liability Limit of Indemnity:
Office Property and Business Interruption
If you require cover for your property, please advise the following:
The total value of your business property (including office equipment and portable devices)
If you require cover for your total business income, please advise the following:
Your total estimated income for the next 12 months (Excluding payments to Temporary workers)
If you only require cover for any Increased Costs of Working following a claim, please provide us with the following:
What would be you estimated increased costs over the next 12 months
Group Personal Accident
If you require cover for your own employees, please provide us with the following:
The total number of employees including Directors and Partners
Please select a sum insured for Death and Capital Benefits
Legal Expenses
If you require cover for Legal Expense, please select form the cover options below:
1) Standard Cover (Excludes Executive Suite and Contractual Liability)
2) Advanced cover (Including Executive Suite and Contract Disputes)
Claims History and Declaration
Can you confirm that You or any Director, Partner or Employee of Your business is not aware of any claim or circumstances that could lead to a Claim during the last 3 years.
If You are aware of any claims or circumstances, please list them below.

Including Date of Loss, Description, Amount Paid, Amount Outstanding:
If you need to provide us with any additional information to help us with your quotation, or you think could influence our underwriting of this insurance policy, please write the details in the box below: