Quotation Request Cleaning Contractors Your Contact Details About Your Business Your Requirements Financial Estimates Optional Covers Work Split External Cleaning Claims Additional Covers Cover Details Calculations ERN Your Contact Details Duty of Fair PresentationIt is your responsibility to provide complete and accurate information to insurers and us prior to and when you purchase an insurance policy, throughout the life of the policy, and when you renew that policy. Failure on your part to immediately disclose information relevant to your insurance or any inaccuracies in the information given could result in your insurance cover being invalid or not fully operative. All statements and material facts disclosed on proposal forms, statements of fact, claims forms and other documents should be full, true and accurate. Material facts are those that would influence an insurer in deciding whether to accept a risk and the terms and conditions that would apply. Where forms are completed or partially completed on your behalf, you should check them for accuracy before signing. If you are in any doubt as to whether a fact is relevant, you should disclose it and then ask for guidance. We are an independent insurance intermediary and offer a specialised range of products and services from Hiscox Limited. We act as an agent of your insurer when operating under a delegated authority agreement. Your name: -- Mr Mrs Miss Ms Dr Prof. Capt. Lord Lady Major Rev. Master Exec(s) of Mx Your email address: Email you will log in with this Forgot your password? Email enter again Password Password enter again Your phone number Address UDPRN UPRN Organisation Line 1 Line 2 Town/City County Postcode Enter address manually or Enter address manually Use address lookup Where did you hear about Gleaming Insurance? - select - Google Search GCC Facebook Instagram Twitter Other If you have a discount code please enter it:Please note, the codes are case sensitive About Your BusinessWhat is your main business activity: - select - Carpet and/or Upholstery CleaningContract / Commercial CleaningDomestic CleaningGutter CleaningOther (not listed)Oven CleaningPressure WashingSoft WashingWindow Cleaning You will be covered for a wide range of activities in addition to your main activity. These will be listed on the final page What type of business do you operate: Sole Trader Partnership Ltd Company LLP - Limited Liability Partnership What is your full legal business name (including partners/principals names if applicable)Eg. Joe Bloggs t/as J Bloggs Cleaning or if Ltd, J Bloggs Cleaning Ltd. This will appear on your documents, so please ensure it is correct. How long have you been in business? Less than 1 year Up to 2 years 2-5 years 5-10 years Over 10 years Do you have anyone else working for your business other than you or your business partner (if you operate a partnership)? YesNo Your RequirementsWhat limit of indemnity do you need for Public Liability Insurance? £1,000,000 £2,000,000 £3,000,000 £4,000,000 £5,000,000 £10,000,000 Please choose the excess you would like for Public Liability £150 £250 £500 £750 £1000 Who is your current insurer? - select - AceAdmiralAgeasAIGAllianzAmTrust AspenAviva AXABerkshire HathawayCatlinCentirckChubbCo-opCoveaDirect LineE SureEcclesiasticalEliteExcelFM GlobalGableGreat LakesHBOSHCCHiscoxInter HannoverLegal & GeneralLiberty MutualLloyds Banking GroupLloyds of LondonLV=MarkelMunich ReNFU MutualNIGNoneOther / UnknownQBERBSRSASterlingTokio MarineTravellersW R BerkleyZurich How many claims have you made in the last 5 years under such a policy? 0 1 2 3 4 5 When do you need cover from? 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2024 2025 **** Hidden*** PL Premium £ Financial Estimates As you have confirmed that you have others working for your business you will need Employers Liability Insurance. Please answer the following questions to enable us to include this coverThe limit of indemnity provided for Employers Liability cover will be £10,000,000 What is your estimated annual turnoverPlease overwrite with your current turnover £ What is your estimated annual wageroll for your employees £ What is your estimated annual payments to self employed cleaners £ What is your estimated annual payments to specialist contractors £ ***** Hidden***** Tools Cover £ Optional Extensions to Cover - VERY IMPORTANT We can include covers that many other insurers can't. Please choose the covers you would like to include from the following; Damage to Property Worked Upon & Treatment RisksThis will provide cover for damage to the item you are cleaning at the time you are cleaning it. It also covers damage caused by chemicals you use. Would you like to include this cover? YesNo Loss of Customer's Keys & Failure to Secure Their PremisesThis covers you for loss of your customer's keys and the cost of replacement locks. Also for claims made where you have failed to lock up correctly. Would you like to include this cover? YesNo Dishonesty (by employees/self employed cleaners)This provides cover for theft by your employees and unauthorised use of customer's telephones by your employees/self employed cleaners. Would you like to include this cover? YesNo It is VERY IMPORTANT that you carefully read this page before proceeding Please confirm you have read and understood the covers you wish to include or exclude. Work Split Is the work your business undertakes Within your customers premisese.g general cleaning, carpet cleaning Outside of your customer's premisese.g window cleaning, pressure washing A mixture of internal and external cleaning External Cleaning Please provide a split of the work you undertakePlease note that we need to know the height at which the cleaner will be working, not the height of the window etc. ALL BOXES MUST ADD UPTO 100% Internal Cleaning % External CleaningWork from the ground % Work Up to 10m in height % Work Up to 25m in height % Work Over 25m in height % **** HIDDEN**** Total Percentage of Cleaning If you work over 25m in height please provideThe maximum height you work at metres The methods used to undertake such cleaning Hidden Height Claims We understand you have suffered 1 claim in the last 5 years We understand you have suffered 2 claims in the last 5 years Please provide full details of each claim including: 1st Incident Date of the incident 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2019 2020 2021 2022 2023 2024 The amount of the claim £ The circumstances of the claim 2nd Incident Date of the 2nd incident 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2019 2020 2021 2022 2023 2024 The amount of the claim £ The circumstances of the claim Additional Covers Commercial Legal Expenses Insurance We can provide cover for Commercial Legal Expenses for an additional premium. The DAS Commercial Legal Protection Policy offers comprehensive cover for all the main areas where legal disputes may arise. Cover includes Employment Disputes & Compensation Awards Property Protection Tax Protection Attendance Expenses (including Jury Service) Bodily Injury Legal Defence For more details of the cover please click hereWould you like to include this cover YesNo Tools & Equipment Cover We can provide cover for Tools and Equipment including hired and owned plant that are used in connection with your cleaning business. Our policies automatically include £1000 of tools and equipment cover - you can choose to increase this amount by selecting from the drop down box here.This cover includes theft, damage and loss to the equipment you use in connection with your business. There are certain terms and conditions with regards to the unattended equipment. For further details please read the Policy Wording. £0 £1,000 £3,000 £6,000 £10,000 £15,000 £20,000 £25,000 £35,000 £50,000 £50,000+ Please specify the amount of cover you require £ Cover Details Set Turnover Auto £ £0.00 Set DamageAuto £ £0.00 Set Loss Keys £ £0.00 Set Dishonesty £ £0.00 Set Discretionary £ £0.00 Set Turnover Load @ % £0.00 Set Excess £ £0.00 Set Claims Discount @ % £0.00 Set + Auto Load £ £0.00 Set Discount Code (always set after min premium load) @ % £0.00 Set Claims Discount @ % £0.00 Set + Auto Load £ £0.00 Set Discount Code (always set after min premium load) @ % £0.00 Set Discount Code (always set after min premium load) @ % £0.00 Set Discount Code (always set after min premium load) @ % £0.00 Total Premium (Net) £0.00 + IPT @ % £0.00 + Policy Fee £ £0.00 Total Premium £0.00 Total Commission £0.00 (Due From Broker) £0.00 CalculationsDo you want to cancel this policy YesNo Remaining days to end of term Internal £ Ground £ Upto 15m £ Upto 25m £ Upto 35m £ Upto 65m £ Internal £ Ground £ Upto 15m £ Upto 25m £ Upto 35m £ Upto 65m £ Legal Expenses £ Damage Calc £ Loss Keys Calc £ Dishonesty Calc £ Removal of Goods Calc £ Am I Imported? YesNo Am I a renewal YesNo Hiscox Policy NumberIf this is a New Business case, leave this field blank - the Hiscox policy number will be populated automatically when the case is placed On Cover.If the client already has an existing Hiscox policy number, by way of a policy not previously set up in SchemeServe, please enter it here: Does this client pay by DDM? YesNo Is this an ANNUAL DDM case? YesNo DO NOT USE YET - TESTING PURPOSES ONLYIf this record is an adjustment and the client does NOT pay by DD, has the premium relating to the adjustment been paid in full by the client / refunded in full to the client? YesNo DO NOT USE YET - TESTING PURPOSES ONLYIf this record is an adjustment and the client does NOT pay by DD, please enter the date of payment of the MTA premium in full by the client, or the date any refund was made in full to the client 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2019 2020 2021 2022 2023 2024 2025 Producer Name Producer Commission Rate Rates Version** Not in use yet ** Documents Version ERNIs the Business exempt from the requirement to have an Employers Reference Number (ERN)? YesNo Please select the exemption reason: - select - All employees are below the PAYE threshold The business is registered outside England, Scotland, Wales or NI The business does not have any employees Do you know your Employers Reference Number (ERN)? YesNo Please provide the ERN below:UK businesses employing one or more people are required to have an ERN (Employer’s Reference Number, also commonly referred to to as the ‘Employer PAYE Reference’), which is a unique reference number for your employees’ income tax and national insurance contributions. You will find your ERN printed or written on mandatory documents including the P45, P60, P11/D and on most payslips. It looks something like this: NNN/Aznnnnn (maybe with up to 7 digits). / If you are unable to provide the ERN at this stage we will contact you at a later date to obtain this information