This Statement of Fact is the record of information provided to Us by Your insurance advisor on Your behalf and in conjunction with the Policy Document and Schedule.
Please take care to review all documentation to ensure that the information provided accurately reflects Your circumstances and that the cover provided suits Your requirements. You should pay particular attention to any terms Conditions limits and Exclusions including Endorsements which may require You to take action.
You confirm that You have answered the questions to the best of Your knowledge and belief and that You have fairly presented the risk to Us. It is very important that You check that the information is accurate and complete and includes all circumstances that might affect Our decision to insure You or the terms upon which such insurance is given. If it is not, please contact Your insurance advisor.
Failure to disclose all relevant facts fully and accurately may invalidate Your Policy or affect the amount We pay You in the event of a claim. If You are unsure whether certain facts are relevant You should disclose them to Your insurance adviser.
The following are statements provided about You
General Declaration
Neither You or any principal partner director or shadow director involved in Your Business has ever:
been convicted or charged with (but not yet tried) or given an Official Police Caution in respect of any criminal offence other than a motoring offence or an offence that is now considered “spent” under the current Rehabilitation of Offenders Act | TRUE |
been convicted of, charged (but not yet tried) with or officially cautioned for a breach of any Health and Safety or Welfare or Environmental Protection legislation | TRUE |
been disqualified under The Company Directors Disqualification Act 1986 from holding a company directorship | TRUE |
had an insurance proposal declined, renewal refused, insurance cover cancelled or special terms applied | TRUE |
been involved or associated with the management of any Company Partnership or Business which has ceased to trade following or as a result of the appointment of a receiver, liquidator, administrator or other insolvency practitioner | TRUE |
been involved or associated with the management of any Company Partnership or Business with an administrator liquidator or a supervisor or nominee under a voluntary arrangement or any compromise or arrangement with creditors whether formal or informal | TRUE |
been served with a prohibition or improvement order under health and safety legislation | TRUE |
had a county court judgement awarded against them | TRUE |
Claims :
there have been no claims in the past five years outside of your membership to the Mobile DJ Network | TRUE |
Liability
no work is undertaken away from the premises involving the use of heat, including welding or cutting equipment | TRUE |
there is no sale, process, treatment, repair or other work undertaken on any products exported to USA or Canada | TRUE |
no employees reside or work outside of Great Britain, Northern Ireland, the Channel Islands or the Isle of Man | TRUE |
no work is undertaken in or around aircraft or airports | TRUE |
no work is undertaken in or around collieries, mines, chemical works, gas works, oil refineries, power stations, offshore installations or bulk oil petrol gas or chemical storage tanks or chambers. | TRUE |
no work is undertaken in or about railways | TRUE |
no work is undertaken in or about canals, viaducts, bridges, tunnels, ships, docks, piers, wharves, breakwater, sea walls, | TRUE |
no work carried out involving exposure to radioactive substances or devices | TRUE |
You do not hold now and have never held an asbestos removal licence in the last 10 years If You or Your employees come into contact with asbestos or asbestos containing materials, work will cease immediately and a licenced sub-contractor will be engaged to deal with such material | TRUE |
Whenever work is carried out by bona fide subcontractors You obtain documentary evidence that such subcontractors have in force public liability insurance providing a limit of liability not less than £5,000,000 or that provided by Your current policy whichever is the lower and that the subcontractors policy covers the work to be undertaken and cover is in force for the duration of such work | TRUE |
Your business annual turnover does not exceed £75,000 | True |
If any of the above statements are FALSE please supply full details in the box below