Application Form

Are you a limited company, registered in England, Scotland, Wales or NI?

Please ChooseYesNo

Are you VAT registered?

Please ChooseYesNo

Do you carry the relevant levels of insurance?

Please ChooseYesNo

Trading Name

Registered Name (if different)

Business Contact Number

Direct Contact Number

Company Reg Number

VAT Reg Number

Employers Liability: £5,000,000 min

Public Liability: £2,000,000 min

Contractors All Risks: £250,000 min

General Reinstatement

YesNo

Drying & Strip-out

YesNo

Out of hours call out

YesNo

Gas Safe

YesNo

CHAS

YesNo

NICEIC

YesNo

Please provide details of the postcode areas you cover in the text box below.

Here at Insurance Builders 4 U, we deal with all aspects of insurance reinstatements, please select yourp preferences I capabilites from the below:

Commercial

YesNo

Capabilites

Below £10KBetween £10k-£30kBetween £30k-£150kOver £150kAll of the above

Year 1: turnover (most recent)

Year 1: % of turnover related to insurance work

Year 3: turnover

Year 3: % of turnover related to insurance work

Please provide details of two references that we can contact in support of your application.

Reference 2 Name

Reference 2 Relation / Position

Reference 2 Company (if applicable)

Reference 2 Contact Number

Reference 2 Email Address

Please provide any additional information that you feel will support your application

I hereby declare that the information provided within this application form is true and correct to the best of my knowledge and belief. I understand that any willful dishonesty or attempt to mislead will render for refusal of this application.

I understand that submission of this application does not guarantee acceptance as an Insurance Builders 4 U Approved Contractor.

By submitting this application I understand and authorise Insurance Builders 4 U. to carry out the due diligence aspects required including (if required) a company credit check.