STATUTORY INSPECTION QUOTATION
PROPOSER
Name
T/as
Trade
Sole Trader
Partnership
Limited
Trading Since
Territory
UK Only
UK & ROI
ROI Only
LOCATION
Address
Postcode
CONTACT DETAILS
Tel
Fax
Mob
Email
Web
WORK ATIVITIES
Your work and % split of each activity :
INSURANCE HISTORY
Required Date
Current Insurer
Policy Num
Premium
Current Broker
INSPECTION SCHEDULE
Plant Type
Make/Model
Serial Num
Year
1
2
3
4
5
6
7
8
9
10
Are All Items Stored At Different Locations:
Is The Plant/Equipment Ever Hired Out:
Has Any Plant/Equipment Been Modified:
If selected (Ticked) give details:
CLAIMS RECORD
Tick if any claim in last 5 years
Give claim details, types, dates :
OTHER INFORMATION
Telephone 02870325999 for assistance