Domiciliary Care Provider / Staffing Agency
Insurance Proposal

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Applicant DetailsBusiness ActivitiesRisk ManagementCovers RequiredClaims & CircumstancesDeclaration

Applicant Details

1. Applicant Details

Which best describes your business? *

Domiciliary or home care providerCare recruitment or staffing agency supplying carers to third partiesBoth a care provider and a care staffing agency

Legal name of business (including any predecessors in business) *

Trading name(s) (if different from legal name)

Date established *

Business structure *

Company registration number (if applicable)

CQC registration number (if applicable)

Principal trading address *

Postcode *

Contact name *

Telephone *

Email address *

Website

Is the firm associated with any other firm(s)? *

YesNo