Recruitment Combined Proposal Form

Section 1: General Information

This section must be completed.

Your Principal Company

Name
Main Office Address
Postcode
Date of Establishment
Website
Contact Name
Email
Phone

Employer Reference Number (ERN)

Following the new regulatory requirements introduced in 2012, we need information from you for the Employer’s Liability (EL) database to ensure claimants can trace insurers in event of an Employers’ Liability claim.

Please provide us with your ERN below

Employer Reference Number

UK Subsidiary Companies

Please state all subsidiary companies which are registered within the UK that will require to be covered under this policy:

Company Name	Employer Reference Number (ERN)

Associate Membership(s)

Please confirm any of the organisations that your company is a corporate member of:
If “Other” please specify

Business Activities

Are you involved in the supply of:
Temporary Workers (PAYE)
Self-Employed or Limited Company Contractors
Candidates (for Permanent Recruitment)
Are you involved in any activities which fall outside of the following
Employment Agency or Employment Business (as defined by the Employment Agencies Act 1973)
Human Resource Outsourcing
Career-related Training and Consulting
If the answer to 5(B) is yes, can you confirm the additional activities that you are involved in;

Estimated Annual Wages

Wages means salaries and other earnings paid, National Insurance, Pensions contributions and Tax to your own employees, engaged for the running of your company, including payments to directors.

Please state the wages or payments made to your own staff employees;	£

Overseas Work

Is all business conducted from within the UK?
Are you involved in any activities for the supply of temporary workers or contractors, for a role which will be based overseas?
If the answer to 7(B) is yes, can you confirm whether all temporary workers supplied will be UK Nationals, and that they are engaged by you as a self-employed contractor?

Your Current Policy

Current Insurer
Renewal Date
Premium Paid	£

Combined Liabilities – Required?

Limits of Liability

Employers Liability
Public and Products Liability

Please state the annual wages or payments made to your Temporary Workers, Self-employed or Limited Company Contractors (“Workers”) supplied to your clients, split between each trade and between your standard Terms of Business and your clients’ contracts (“Non-Standard Contracts”).

Trade of Worker	Standard Terms	Non-Standard Contract Terms
Clerical	£	£
Professional	£	£
IT	£	£
Medical & Nursing (exc. Domiciliary Care)	£	£
Drivers, Light Industrial, Blue Collar & Hospitality	£	£
Security	£	£
Manual, Heavy Construction & Civil Engineering	£	£
Safety-critical Railway Workers	£	£
Other Hazardous Professions	£	£
Domiciliary Care	£	£
Nannies	£	£

Hazardous Work

Do you supply any temporary workers which involved work on or in any of the following areas?

Power stations or nuclear installations or establishments
Oil, gas or chemical which are used for refining, bulk storage or production
Aircraft, aerospace systems or hovercraft
Ports or docks
Watercraft or ships
Railways or airports
Underground work, including mining, quarrying or tunnelling
Mainframe computers or rooms containing mainframe computers
Underwater
Offshore
If yes, please provide details in the “Additional Information” section at the end of this form.
Drivers Negligence Cover – Required?

Limits of Liability

Please select your preferred limit in respect of any one claim
Please select your preferred limit for any one period of insurance

Driver Estimates

Please estimate the maximum number of drivers supplied at an one time

Wrong Fuel Type Extension

Do you require cover in the event that a temporary driver mis fuels a vehicle?
Fidelity Bonding Cover – Required?

Contract Details

Please state the contracts that you have which requires Fidelity Bonding;

Contract Name	Types of Goods Handled	Indemnity Required	Contract Turnover

Professional Indemnity – Required?

Limits of Liability

Please select the limit of indemnity you require

Gross Turnover

Please confirm your gross turnover for both your last financial year and your forthcoming year.

Last Financial Year	Forthcoming Financial Year
Total Turnover	£	£

Turnover Breakdown

Please provide a breakdown of Total Turnover by Standard and Non Standard Terms of Business.

Last Financial Year	Forthcoming Financial Year
Standard Terms of Business (Temporary and Permanent Recruitment)	£	£
Non Standard Contracts	£	£

Please provide a breakdown of Total Turnover generated in the following territories.

UK & EU	%	%
Worldwide exc. USA / Canada	%	%
USA / Canada	%	%

Responsibility for the acts of your Worker(s) supplied

Are you made responsible under any contracts for the acts or omission of the workers that you supply? If yes, please answer (B) and (C) below.
Please state the percentage of your turnover which relates to these contracts	%
Will any of these contracts be for the supply of workers in the following professions?
Banking
Medical Professionals
Actuaries
Financial Advisors
Qualified Solicitors
Anyone working in the Oil and Gas industry

Retroactive Date

Please note that your retroactive date can be found under the professional indemnity section on your current policy schedule.

Please state your current retroactive date

Material Damages & Business Interruption – Required?

Your Additional Office Premise(s)

If you have additional office locations that need to be included, please list them below

1	Main office address (already specified at the beginning of this form)
2
3
4
5

Property Sums Insured Required

Premises
1	2	3	4	5
Computers	£	£	£	£	£
All other contents	£	£	£	£	£
Tenants Improvements	£	£	£	£	£
£	£	£	£	£

Fire and Security

Please advise if you have a security alarm
Do you have a Fire Alarm?
If yes, is this alarm subject to a maintenance contract with a Loss Prevention Council, NSI or SSAIB approved company?

Specified Business Equipment

Please state any property to be insured whilst away from the premises (such as laptops or mobile phones), the sum insured for the total of the items, and the region.

Description of Item(s)	Sums Insured	UK, Europe or Worldwide
Laptops	£
Mobile Phones	£
Other – Description:	£

Business Interruption

Please specify your preferred your required sums insured.

Insured Items	Sums Insured
Option A	Loss of Revenue including Additional Expenditure	£
Option B	Loss of Revenue including Additional Expenditure (but excluding payments made to temporary workers supplied)	£
What period do you require Loss of Revenue to be insured over?

Or

Option C	Additional Office Expenditure Only	£
What period do you require Additional Expenditure to be insured over?

Outstanding Debit Balances

Please estimate the maximum amount of debit balances that could be outstanding at any one time.

Sum Insured	£

Buildings

Premises
1	2	3	4	5
Buildings Sum Insured	£	£	£	£	£
Rent Receivable	£	£	£	£	£
Are all buildings
Built to standard construction?
Are there any signs of damage that could be due to subsidence, landslip or heave?

Legal Expenses – Required?

Legal Expenses

Please select the limit of indemnity you require

Gross Turnover

Please confirm your gross turnover for both your last financial year and your forthcoming year.

Last Financial Year	Forthcoming Financial Year
Total Turnover	£	£

Group Personal Accident – Required?

Personal Accident

The standard policy will provide a fixed benefit of up to £10,000 for death, loss of limb(s) and loss of sight.

Do you require cover for your own permanent employees?
Do you require cover for temporary workers?
Please confirm the average number of temporary workers at any one time, split between manual and non-manual
Manual	Non-Manual
Number of Temporary Workers

Directors and Officers Insurance – Required?

Limits of Liability

Limit Required
Directors and Officers Liability

Extensions

Required?	Limit Required?
Employment Practice Liability
If required, please provide the number of own employees
Entity Cover

Cyber Liability – Required?

Do you have one or more firewalls installed on your organisations network boundary to restrict inbound and outbound network traffic to authorised connections?
Do you have antivirus software installed on all computers that are connected to or capable of connecting to the internet and configured to update automatically or through the use of centrally managed deployment?
Are updates and security patches applied to software running on all computers and network devices that are connected to or capable of connecting to the internet in a timely manner (no later than 30 days after release)?
Is all business-critical data is backed up at least once a week?
Is all sensitive data stored on backup media and portable devices encrypted?
With regards to cyber security, have there been any claims or incidents in the last five years?
Are there no more than 500,000 personal records stored?

Please select the limit of indemnity required	Limit Required
If “Other” please specify the limit you require	£

Claims Declaration

After full enquiry, is any director, partner, principal, or employee aware of any claim over the last 3 years under any insurance policies identical or similar to those insurances for which you are now requesting quotations (whether or not such insurances are currently in force)?
After full enquiry, is any director, partner, principal, or employee aware of any potential claim, incident or circumstance that would or may have given rise to a claim under any of the proposed insurances for which you are now requesting quotations?
After full enquiry, is any director, partner, principal, or employee aware of further facts that may affect the proposed insurances for which you are now requesting quotations?

If yes, please give full details, including any actual or estimated settlement cost:

Date of Loss	Section of cover claimed under	Amount paid	Or Outstanding Estimate

Additional Information

Please provide any additional information which you believe is material to the insurances that you have requested cover for.

General Declaration

Declaration

In proceeding with this proposal, and with any subsequent insurance contract, I/we declare that any statements made by me/us whether on my/our own or on others’ behalf are accurate and complete to the best of my/our knowledge and belief, and I/we acknowledge and agree that they will form part of the contract with insurers. I/We agree to accept a policy in the insurer’s normal form for this class of business. Before proceeding to the next stage in the Proposal, please check your answers carefully. Proceeding with this proposal does not bind either you or the insurers to complete the insurance until such time as you specifically agree to purchase the insurance quoted and the insurers specifically agree to provide the insurance. The proposal and any supporting information supplied will be the basis of any resulting contract or insurance and will be incorporated into the contract. All questions must be answered fully and truthfully to the best of your knowledge and belief. If you consider that any questions require knowledge which you do not have or are not sure of, you should contact us to outline your concerns. All material facts must be disclosed, including any which might arise or change between the date of this Proposal and the start date of any contract of insurance based upon this Proposal. Failure to do so may render any such contract null and void. A material fact is one likely to influence acceptance or assessment of this Proposal. If you are in any doubt as to what constitutes a material fact you should disclose it. If you are in any way unsure, you should contact us to outline your concerns. We recommend that you keep a record, including copies, of this Proposal for and all information supplied to us for the purpose of entering into this contract. Copies of your responses will in any event be attached to your quotation for convenience.

Acceptance of Declaration

I confirm that I have read and understood the above declaration.

Name:

Position:

Signature:	_____________________________

Date:	25 January 2022