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Your Details
First name *
Surname *
Company name (if applicable)
Address *
Postcode *
Telephone number *
Email address *
Home Details
Established *
Type of Care
Number of Registered Beds in each category of care:
Number of day care places
Facilities Provided (eg swimming pools)
If available to non residents how is access controlled
Level of qualification and supervision provided
Health & Safety Policy in force
YES
NO
Risk Assessments complete and up to date
YES
NO
Full training provided
YES
NO
Use of lifting hoists
YES
NO
Details of any other manual handling equipment
Date of last Regulatory Inspection
All requirements completed
YES
NO
Details of any requirements still outstanding
Qualifications of staff
If most not at least NVQ 2 details of working practises and how supervision implemented
Type of Premises
Construction of roof
Construction of floor
Type of heating
Security details
Sums Insured
Buildings
Tenants Improvements
Trade Contents
Stock
Frozen Food
Computers
Residents Effects
Household Contents
Personal Possessions
Business Interruption
Estimated Gross Profit
Indemnity Period
Months
Loss of Registration required
Public & Employers Liability
Any work away from premises?
YES
NO
Claims
Details of claims in last five years
Further Information
Holding Broker
Present Insurer
Date cover required *
(dd/mm/yyyy)
Target Premium
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