Proposal Form For Recruiters - Blackmore Borley : Blackmore Borley

Company Name

Principle Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Please list any subsidiaries to be insured and the number of locations:

Contact Number

Email Address *

Email

Confirm Email

Website Address *

How many staff are currently employed?

Permanent

Please type in the number of staff or use the up and down arrows.

Part Time

Please type in the number of staff or use the up and down arrows.

What is the firm’s Gross Turnover?

Current Financial Year (estimate)

Previous Financial Year

What is your estimated % of gross turnover generated by temporary placements

Please type in your estimated %

What is the % of temporary placements, outside IR35? (Please use slider)

Selected Value: 0

Please provide an estimated % split of the following.Totals should add up to 100%

Manual

eg Drivers, Construction

White Collar

e.g. Executives, IT, Management, Teachers, Legal, Clerical etc

Medical

Nurses, Care Workers ( Other Medical please list)

Other

Please list "Other"

Your totals should add up to 100%

What % of placements are located in (should add up to 100%)

UK

Please type in your estimated % or use the up and down arrows.

Europe

USA / Canada

Rest of World

What P.I. Limit do you currently purchase?

Last year's premium ?

What is you current Self-Insured Excess Deductible?

Retroactive Date, if any?

Coverage is afforded to circumstances that occurred on or after this date and made during the current policy period. (Often it is the date you first bought insurance.)

What Professional Indemnity aggregate limit would you like to purchase?

What level of HMRC Cover would you like?

Please note that a £25,000 aggregate limit for HMRC investigation cost is already included.

Do you or your subsidiary companies activities include umbrella or payroll?

Yes
No

Are standard contracts used for both permanent and temporary placements?

Yes
No

Do such contracts carry a hold harmless provision for the work undertaken by the placed staff?

Yes
No

Are all clients’ requirements agreed in writing?

Yes
No

Are all contracts regularly reviewed with the clients?

Yes
No

Where applicable are all candidates:

a. Qualifications and/or skill set verified?

Yes
No

b. Interviewed prior to placement?

Yes
No

c. Confirmed to have the ability to work in the UK?

Yes
No

d. Confirmed to have no criminal record?

Yes
No

e. Checked to hold a valid driving licences?

Yes
No

f. References sort sought and recorded?

Yes
No

Declarations:

Are you aware after full enquiry of any claims or circumstances that could rise to a claim under this policy?

Yes
No

If yes please do provide details on referral form below.

When applicable, are placements independently verified to be outside IR35?*

Yes
No

What % of contracts are verified independently to be outside IR35 *

*Please note that insurance for HMRC investigation costs will only apply to those placements that have been independently verified to be outside IR35 prior to the beginning of the placement.

Please confirm:

I agree that the information I have given above has been given in good faith, and accurate to the best of my knowledge

Referral Form

Hi there thanks for enquiring about Blackmore Borleys Recruiters Insurance, in this instance we do need to run through a few details with you, before confirming a price for your policy

Can you confirm the best method of contacting you and we will be in touch within 2 working days

Your Name *

First

Last

Contact Details

Any comments notes you wish us to have before our call?