Recruitment Agency Proposal Form Question Title * Your BusinessCompany Name Question Title * Main Office Address Question Title * Subsidiary Companies Question Title * Date Business Established Date Date Question Title * 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 ActivitiesPlease confirm: Question Title * Do you deal with the placement of permanent staff? Yes No Unknown Please confirm the turnover percentage Question Title * Do you supply Temporary Workers under a Contracts for Services? Yes No Unknown Please confirm the turnover percentage Question Title * Do you supply temporary Self-Employed or Personal Service Companies (PSC)? Yes No Unknown Please confirm the turnover percentage Question Title * Other business activities, not mentioned above (Please provide details below) Yes No Unknown Please confirm the turnover percentage Question Title * Please confirm details Question Title * Do you place your own Employed staff out on temporary contracts? Yes No Unknown Question Title * Please provide your average percentage fee you achieve on the placement of Temporary workers (e.g. 10%-15%) Question Title * If you sign Hirer’s Contract Terms (Non-Standard Contracts), what percentage of your turnover is generated from these contracts? Question Title * TerritoriesPlease provide a percentage breakdown of turnover generated in the following territories: The UK and Europe The rest of the World excluding USA and Canada USA and Canada Professional Indemnity Cover Question Title * Please select your required Professional Indemnity Limit of Indemnity £100,000 £250,000 £500,000 £1,000,000 £2,000,000 £5,000,000 £10,000,000 unknown Question Title * Please confirm your total turnover during your last completed financial year Question Title * Please confirm your estimated turnover for your next financial Year Question Title * Do you sign Hirers Contracts where you are required to cover the negligent acts errors and omission of the Temporary Workers (Vicarious Liability)? Yes No Unknown Question Title * Do you require cover for the Dishonesty of Temporary Workers you place? Yes No Unknown Question Title * Please let us know the Retroactive Date on your current policy Date Date Question Title * Combined LiabilityThe limit of indemnity for Employers Liability will be £10,000,000.Please select your required Public Liability £1,000,000 £2,000,000 £5,000,000 £10,000,000 unknown Question Title * Please confirm the percentage split for the type of Temporary Workers Placed: Clerical Professionals Professional Medical and Care workers Heavy Manual including Construction and Engineering Light Manual including Retail, Warehouse, and Manufacturing Drivers Temporary workers using Heat Equipment (Excluding Soldering Irons) Red Zone Rail workers Drivers Negligence Question Title * Any One Claim: £5,000 £10,000 Unknown Question Title * Total amount of Claims during Any One Period of insurance: £30,000 £50,000 £100,000 Unknown Question Title * What percentage of the drivers you supply require Drivers’ Negligence insurance: Directors and OfficersIf you require cover for Director and Officers, please confirm the limits and covers you require: Question Title * Directors and Officers limit of indemnity: £100,000 £250,000 £500,000 £1,000,000 £2,000,000 Unknown Question Title * Company Reimbursement / Entity Cover Limit of Indemnity: £100,000 £250,000 Unknown Question Title * Employment Practices Liability Limit of Indemnity: £100,000 £250,000 £500,000 Unknown Office Property and Business InterruptionIf you require cover for your property, please advise the following: Question Title * 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: Question Title * 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: Question Title * What would be you estimated increased costs over the next 12 months Group Personal AccidentIf you require cover for your own employees, please provide us with the following: Question Title * The total number of employees including Directors and Partners Question Title * Please select a sum insured for Death and Capital Benefits £Nil £10,000 £25,000 Unknown Legal ExpensesIf you require cover for Legal Expense, please select form the cover options below: Question Title * 1) Standard Cover (Excludes Executive Suite and Contractual Liability) Yes No Unknown Question Title * 2) Advanced cover (Including Executive Suite and Contract Disputes) Yes No Unknown Claims History and Declaration Question Title * 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. Yes No Unknown Question Title * If You are aware of any claims or circumstances, please list them below.Including Date of Loss, Description, Amount Paid, Amount Outstanding: Question Title * 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: Next
