1. Years claim free for buildings claims:

2. Years claim free for contents claims:

3. Been convicted of or charged with (but not yet tried) a criminal offence other than a motoring offence or a spent conviction in accordance with the “Rehabilitation of Offences Act 1974”?

4. Been disqualified from being a company director?

5. Been declared bankrupt or are the subject of any bankruptcy proceeding, liquidation, administration, IVA, any voluntary or mandatory insolvency or winding up procedures?

6. Had any County Court judgement or a Sheriff Court decree?

7. Been prosecuted or have prosecution proceedings under the Health and Safety Work Act or any other statute or regulation?

8. Had any insurance proposal declined, renewal refused, a policy cancelled mid-term by underwriters, a policy declared void, a claim repudiated, or had any special or increased terms applied?

9. During the last 5 years have you been prosecuted or has any enforcement action, including any requirements for clean up or environmental restoration, been taken against you for contravention of any standard regulations or law relating to the release of any substance from any location into sewers, rivers, sea or onto land?

10. At the time of making this insurance application are you aware of any incident or circumstance that could reasonably be expected to have given rise to a claim, prosecution or enforcement action?