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Opening Hours

Motor Trade Road Risks, Commercial Vehicle
Monday-Friday: 8:30am-8pm
Saturday: 9am-1pm

Courier Insurance
Monday–Friday: 9am–6pm

Motor Trade Combined, Personal Lines, Business
Monday-Friday: 8:30am-5:30pm

Commercial Lines, Care & Charity Insurance, Risk Management, Taxi Insurance
Monday-Friday: 9am-5:30pm

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01625 348029

Domiciliary Care and Home Support Insurance Quote Form

About You
Contact Name
Telephone Number
Email
Company Name
Postcode
House Name/Number
Line 1
Line 2
Town
Are you registered with CQC?
Yes      No
If no, please explain the reason why?
Is nursing care provided?
Yes      No
If so, approximately what percentage of your turnover is attributed to Nursing?
Do you loan staff to third party care homes/hospitals?
Yes      No
If so, approximately what percentage of your turnover is attributed to loaning of staff?
Do provide care to service users that display challenging behaviour?
Yes      No
If so, briefly describe the nature of the challenging behaviour, i.e EBD, Dementia, Anger & Aggression?
If so, approximately what percentage of your turnover is attributed to challenging behaviour?
Will you accompany your clients on holiday?
Yes      No
Do you have a protection of vulnerable adults policy in place?
Yes      No
Target Premium
Has any Director or Partner of this company, been involved in any previous company which has gone into bankruptcy, insolvency or liquidation?
Yes      No
Has any Director or Partner of this company any criminal convictions or pending criminal convictions?
Yes      No
Has any Insurer declined your proposal, cancelled or refused to renew your policy, required an increased premium or imposed special terms?
Yes      No
Cover Details
Date Business Established
If this is a new company, what is experience and qualifications in the care, health and social work industry are held by yourself or other managers?
When is your policy due for renewal?
Who is your existing insurer?
Anticipated Turnover for the coming year - £
Client group, please indicate percentage of turnover below:
Elderly
%
Mental Health
%
Learning Difficulty
%
Drug / Alcohol Rehabilitation
%
Physical Disability
%
Service Users Under 18 Years Of Age
%
Other Please Specify
Claims History (Please supply full details)
Do you carry out DBS checks?
Yes      No
Do you carry out ID checks and references for all staff?
Yes      No
Do you require buildings cover/personal accident?
Yes      No