Quotation Request Courier Liability Client Details Declaration Goods Carried Vehicles Subcontracting Covers Claims Cover Details *Hidden* Calculations Client DetailsCustomer Type - select - Individual Company Insured Name -- Mr Mrs Miss Ms Dr Prof. Capt. Lord Lady Major Rev. Master Exec(s) of Mx Trading Name Company Name Company Type - select - Limited Company Partnership Sole Trader LLP Correspondence Address UDPRN Organisation Line 1 Line 2 Town/City County Postcode Enter address manually or Enter address manually Use address lookup Business Type - select - Courier Light Haulage Client Email & PasswordPlease create a password using at least: * 8 Characters * 1 Capital Letter * 1 Number * 1 Special Character Special Characters: ~`!@#$£%^&*()_-+={[}]|:;"'<,>.?Please create a password using at least: * 8 Characters * 1 Capital Letter * 1 Number * 1 Special Character Email you will log in with this Forgot your password? Email enter again Password Password enter again What would you like a quote for? - select - Goods in Transit Public & Employers Liability Goods in Transit & Public & Employers Liability Promotional Code Declaration Have you, any partner, principal, director of the business, or any other business in which you have been trading:- Been disqualified under the Company Directors Disqualification Act 1986 or any other subsequent legislation or The Insolvent Companies (Reports of Conduct of Directors) (Scotland) Rules 1996 YesNo Was the disqualification over 10 years ago? YesNo Please provide details: Been convicted of or charged with but not tried for a criminal offence other than a motoring offence YesNo Please provide details: Been declared bankrupt or insolvent or been the subject of bankruptcy proceedings either as a private individual or in connection with any business YesNo Were proceedings concluded over 5 years ago and the outstanding debt less than £50,000? YesNo Please provide details: Been proscecuted under the Health and Safety at Work Act or similar legislation or had any disciplinary proceedings or investigation brought by any Regulatory Body or been requested to attend and enquiry or tribunal YesNo Were proceedings concluded over 5 years ago and any fines/penaltiesimposed less than £25,000? YesNo Please provide details: Been the subject of a county court judgement in respect of debt either as a private individual or in connection with any business YesNo Please provide details: Had an insurance contract cancelled or declared void or a claim repudiated or renewal refused YesNo Please provide details: Please advise You, any partner, principal, director of the business is domiciled in the United Kingdom and/or the Isle of Man and/or the Channel Islands? YesNo Please provide details: The business does not derive more than 50% of its turnover from activities outside of The United Kingdom and/or the Isle of Man and/or the Channel Islands? YesNo Please provide details: You comply with workplace, product safety and environmental legislation? YesNo Please provide details: You have not been prosecuted under any workplace, product safety and environmental legislation during the last five years? YesNo Please provide details: You, confirm the business or activities of the business does not involve any work carried out at or in connection with: Any work of the business in any territory other than the EEA and no more than 50% of the annual turnover or activities are outside of the United Kingdom YesNo Please provide details: High risk premises such as power stations, gas works, chemical works, oil refineries, nuclear installations or nuclear establishments other than collection and delivery only to non-process/clerical areas of such locations YesNo Please provide details: Work on or around offshore installations YesNo Please provide details: The carriage of Hazardous goods classified as 1 and 7 as defined by the ADR regulations www.hse.gov.uk/cdg/manual/classification YesNo Please provide details: You do not use or operate of any lifting plant or apparatus other than Vehicle tail lifts or Fork Lift Trucks YesNo Please provide details: You do not use or operate any vehicle in excess of 7.5T M.A.M. (Maximum Authorised Mass) YesNo Please provide details: You do not undertake or operate any skip hire or Waste transfer activities YesNo Please provide details: You do not have any responsibility for or own any toxic waste or landfill sites YesNo Please provide details: You are not involved in the installation of any goods / products YesNo Please provide details: You have had no Public, Products or Employers Liability claims or incidents which could give rise to a claim in the past five (5) years YesNo Please provide details: You are not involved in the delivery of any convenience and/or takeaway foods and /or beverages from any restaurant, public house and/or food outlet for home delivery YesNo Please provide details: You confirm that you do not operate any bicycles and/or motorcycles YesNo Please provide details: Goods CarriedI confirm that we do not carry any toxic, notifiable or dangerous waste &/or clinical waste as defined in the Hazardous Waste (England & Wales) Regulations 2005, The Hazardous Waste (Northern Ireland) Regulations 2005 and The Special Waste Amendment (Scotland) Regulations 2004 YesNo Please provide details: I confirm that we do not wittingly carry Hazardous goods classified under Sections 1 and 7 under the ADR guidelines / regulations (https://www.hse.gov.uk/cdg/manual/classification.htm) and do not carry other ADR classed goods outside of guidelines YesNo Please provide details: I confirm that we do not wittingly carry full loads of:1. Bottled perfumes, bottled alcoholic spirits, Processed tobacco and tobacco products 2. Computer memory, CPUs, storage devices, display devices (monitors), graphic cards, motherboards or any similar hi-tech item components; or mobile phones, portable computing devices (tablets, laptops and similar), computers or videogame hardware, peripherals or software 3. Fine art, watches and articles made of or containing precious metals and/or precious stones 4. Any household, office or other similar removals YesNo Please provide details: I confirm that the following goods are excluded under our conditions of carriage:1. Living Creatures 2. Money, including cash, bank and currency notes, bullion, any securities for money, negotiable instruments, savings stamps, money orders or any other instrument representing money 3. Precious metals or precious stones YesNo Please provide details: I confirm that cover is not required for Climate Controlled goods YesNo What is the percentage of turnover relating to temp controlled carriage? % Vehicles Should you wish to change the covers applicable to individual vehicles please use the the drop down box and highlight your vehicles one by one and make the appropriate changes required Vehicle Registration Please note that all vehicles will adopt the highest requested Single Vehicle Limit and will therefore be charged at that level. Limit any one vehicle (General Terms and Conditions) - select - £12,500 £17,500 £22,500 £27,500 £32,500 £42,500 £52,500 Do you require a vehicle limit of £100,000 for specific contracts? YesNo Please tick all companies Amazon DHL DHL Service Point DPD DPD Group Fed Ex Evri Parcel Force Royal Mail TNT Express TNT UK Limited United Parcel Services Yodel If 'Other' option is selected please email Henry Haystead Other Other Details What percentage of your company turnover is required to be carried at £100,000 - select - Less than 25% 25-49% More than 50% HIDDEN CALCS VehicleLimit100K *HIDDEN* This field is auto populated via rating file. £ VehicleLimit100KCharge *HIDDEN* This field is auto populated via rating file. £ Do you want to add another vehicle? Number of vehicles on this policy*HIDDEN* This field is auto populated via rating file. Vehicle 1 Limit*HIDDEN* This field is auto populated via rating file. Vehicle 2 Limit*HIDDEN* This field is auto populated via rating file. Vehicle 3 Limit*HIDDEN* This field is auto populated via rating file. Vehicle 4 Limit*HIDDEN* This field is auto populated via rating file. Vehicle 5 Limit*HIDDEN* This field is auto populated via rating file. Total Vehicle Limit*HIDDEN* This field is auto populated via rating file. Vehicle 1 Limit Charge*HIDDEN* This field is auto populated via rating file. Vehicle2LimitCharge*HIDDEN* This field is auto populated via rating file. Vehicle 3 Limit Charge*HIDDEN* This field is auto populated via rating file. Vehicle 4 Limit Charge*HIDDEN* This field is auto populated via rating file. Vehicle 5 Limit Charge*HIDDEN* This field is auto populated via rating file. TotalVehicleLimitCharge*HIDDEN* This field is auto populated via rating file. Total Vehicle Limit 100K*HIDDEN* This field is auto populated via rating file. Total Vehicle Limit 100K Charge*HIDDEN* This field is auto populated via rating file. Vehicle 1 Turnover Percentage*HIDDEN* This field is auto populated via rating file. Vehicle 2 Turnover Percentage*HIDDEN* This field is auto populated via rating file. Vehicle 3 Turnover Percentage*HIDDEN* This field is auto populated via rating file. Vehicle 4 Turnover Percentage*HIDDEN* This field is auto populated via rating file. Vehicle 5 Turnover Percentage*HIDDEN* This field is auto populated via rating file. Total Turnover Percentage*HIDDEN* This field is auto populated via rating file. SubcontractingIs cover required for subcontractors? YesNo Do payments to subcontractors exceed 30% of your estimated annual turnover? YesNo Please provide details: CoversIs Public and Products Liability cover required? YesNo Public Liability Indemnity Limit - select - £2,000,000 £5,000,000 £10,000,000 Is Employers Liability cover required? YesNo Number of Clerical Employees Number of Manual Employees Employers Liability Limit £10,000,000 ERN Exempt? YesNo ERN Exempt Reason: Are you able to supply the ERN now? YesNo ERN Details will need to be supplied within 14 days ERN Details ERNUK businesses employing one or more people are required to have an ERN (Employer’s Reference Number, also commonly referred to to as the ‘Employer PAYE Reference’), which is a unique reference number for your employees’ income tax and national insurance contributions. You will find your ERN printed or written on mandatory documents including the P45, P60, P11/D and on most payslips. It looks something like this: NNN/Aznnnnn (maybe with up to 7 digits). / Annual UK Turnover £ Annual Europe Turnover £ Annual payments to bona-fide subcontractors £ Number of Vehicles ClaimsHave you had any claims for Freight Operators Liability Insurance (Goods in Transit) in the past 3 years exceeding £2,500 or more than two claims during this period? YesNo Please provide details: Cover Details Set Vehicle Discount @ % £0.00 Set *MTA* Vehicle Charge £ £0.00 Total Premium (Net) £0.00 + IPT @ % £0.00 + Policy Fee £ £0.00 Total Premium £0.00 Total Commission £0.00 (Due From Broker) £0.00 *Hidden* CalculationsAxaRateVersion AxaDocumentVersion AxaUMR AxaPolicyWording FiduciaRatesVersion FiduciaDocumentVersion FiduciaUMR FiduciaPolicyWording PolicyNumberPrefix Rating PL Limit of Indemnity £ Annual UK Turnover £ Annual Europe Turnover £ Annual BFSC Payments £ EL Limit of Indemnity £ Excess £ Courier Policy Fee £ Liabilities Policy Fee £ MTAs & Cancellations HiddenAnnualDays HiddenMTADays CancellationReason - select - Alternative product purchasedCancelled by InsurerCancelled due to non-payment of premiumCancelled within cooling off periodCover no longer requiredCover overlapped with existing cover in placeNot KnownOther (administrative reason)Poor service or complaintToo expensive or found cheaper cover elsewhereUnsuitable or misunderstood Record Type Status