Insurance for hairdressers | Insurance for beauty therapists | Beauty salon insurance | Mobile hairdressers insurance | Self employed beauty insurance

BUSINESS/PERSONAL DETAILS

Full Name of Proposer (Including Trading Name)

Address of Salon

Post Code       Telephone No.

Postal Address (if different from above)

Post Code       Telephone No.

Full Business Description

Inception Date of Cover Required

How long have you been in business

Number of years experience

Details of relevant industry qualifications

Are your books kept up to date and would be available upon request
Yes No

Are you registered for VAT
Yes No

Previous Insurers Name and Policy Number (if known)

GENERAL QUESTIONS

In respect of any Risks now Proposed for any business in which you the Proposer or any Partner or Director are or have been engaged in have you -

(a) ever been convicted of or charged (but not yet tried) with a criminal offence other than a motoring offence
Yes No

(b) ever had an insurer decline to offer insurance to you
Yes No

(c) ever had an insurer cancel or refuse to renew your policy
Yes No

(d) ever had an insurer require an increase premium or impose special terms
Yes No

(e) ever been declared bankrupt or are the subject of any bankruptcy proceedings or any voluntary or mandatory winding up procedures
Yes No

If you have answered ‘Yes’ to any of the above please give full details below, including any dates.

SUMS INSURED, LIMITS & ESTIMATES

EMPLOYERS LIABILITY
Legal liability for employees with £10,000,000 indemnity any one incident

PUBLIC & PRODUCTS LIABILITY
Legal liability to the public with £2,000,000 indemnity any one incident

PROFESSIONAL TREATMENT
Legal liability to the public resulting from treatment given.
£2,000,000 indemnity in total in any one policy period.

1. Please provide the following information

2.Is Employers Liability Required?
Yes No

As of April 2011 due to the requirements of the Employers Liability Tracing Office, the Employer Reference Number (ERN) must be supplied for the Insured and all subsidiary companies, cover cannot be effected without this number.

Employer Reference Number (s)

3. The policy can provide cover for numerous treatments, which are listed in different categories. Please tick those categories required, underlining the treatments carried out.

If you undertake any treatments that are not listed above then please name below and provide full details and attach as much information as you can regarding said treatment.

CLAIMS EXPERIENCE

Please detail below any claims, losses or incidents made by you or against you, within the last 5 years, whether insured or not. Please specify dates and provide as much information as possible. Please also specify if the claim is still outstanding. If none please state ‘None’.

Declaration

I/We declare that to the best of my knowledge and belief all statements and particulars given by me/us are true and complete and that no material information or fact has been withheld or suppressed

I am /We are authorised to sign on behalf of all proposers

I/We agree

- that this proposal will be the basis of the contract between me/us and Groupama Insurance Company Ltd

- that if any answers have been written by another person then for the purpose such person will be regarded as my/our agent and not the agent of Groupama Insurance Company Limited.
- To be bound by the terms and conditions of the policy

I/We understand that

- the liability of Groupama Insurance Company Limited does not commence until this proposal has been accepted by them

- Groupama Insurance Company Limited reserve the right to decline any proposal

I/We agree to the seeking of information from credit and other agencies in connection with this proposal

Proposers Name    Email    Date

I agree to the above declaration

Any Additional Comments

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