Application Form

    Pre-Qualification Questions

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

    Have you been registered for more than 2 years?

    Are you VAT registered?

    All you an all trades contractor, capable of carrying out all aspects of building reinstatament?

    Do you carry the relevant levels of insurance?

    Do you have an up to date H&S Policy, in accordance with the most current legislation?

    Contact Details

    Trading Name

    Registered Name (if different)

    Director/ Owner Name(s)

    Name of Person Making Application

    Business Contact Number

    Direct Contact Number

    E-mail Address

    Web Address

    Company Reg Number

    VAT Reg Number

    Business Address

    Insurance Details

    Employers Liability: £5,000,000 min

    Public Liability: £2,000,000 min

    Contractors All Risks: £250,000 min

    Number of PAYE Staff

    1-1011-5050+

    Do you CRB Check your Staff?

    YesNoN/A

    Number of Sub-Contractors

    1-1011-5050+

    Service Provider

    General Reinstatement

    YesNo

    Drying & Strip-out

    YesNo

    Out of hours call out

    YesNo

    Asbestos Sampling

    YesNo

    Asbestos Removal

    YesNo

    Commercial

    YesNo

    Certifications & Accreditations

    Gas Safe

    YesNo

    CHAS

    YesNo

    NICEIC

    YesNo

    CIOB

    YesNo

    IOSH/ NEBOSH

    YesNo

    Drying Qualification

    Membership Preferences

    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:

    Total Reinstatement

    YesNo

    New Build - From Plan

    YesNo

    Commercial

    YesNo

    Capabilites

    Financial Assessment

    Year 1: turnover (most recent)

    Year 1: % of turnover related to insurance work

    Year 2: turnover

    Year 2: % of turnover related to insurance work

    Year 3: turnover

    Year 3: % of turnover related to insurance work

    Please provide details of any insurance networks that you currently, or have previously, worked on

    References

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

    Reference 1 Name

    Reference 1 Relation / Position

    Reference 1 Company (if applicable)

    Reference 1 Contact Number

    Reference 1 Email Address

    Reference 2 Name

    Reference 2 Relation / Position

    Reference 2 Company (if applicable)

    Reference 2 Contact Number

    Reference 2 Email Address

    Additional Information

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

    Declaration

    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.