PLANT/ENGINEERING/EQUIPMENT 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 Number
Premium
Current Broker
PLANT SUM INSURED
Market Value of Own Plant
(Total)
Own Plant Max Item Value
Give Specific Details Of Items Valued Over 5000 (Market Value)
Type
Make
Serial
Mkt Value
Year
1
2
3
4
5
6
7
8
HIRED PLANT EXTENSION
If this extenison is required give the following details:
Is the Plant Ever Hired Out
Is Plant Ever Hired In
Hired In Plant Fees Paid
Hired Out Plant Earnings
Max Value Item Hired
If Plant is "Hired Out" A copy of the Hire Agreement will be required
CLAIMS RECORD
Tick if any claim in last 5 years
Give claim details, types, dates :
OTHER INFORMATION
Telephone 02870325999 for assistance