Instructors / Therapists quote

Please only complete & submit the following details if you are applying for a quotation in your individual name.

If you require a quotation for a Limited Liability Company, please contact us on 01252 735806

For First Aid and/or Health and Safety please see the separate First Aid form under the Quote Request Menu

Full Name
Are you applying as an individual?	YesNo If yes please go straight to address details. If no, what is your Company name and your company’s legal status?
Company Name
Company Legal Status	Other:
Under what name do you trade?	This is the name that will be shown in your policy
Who are the Directors, Partners, Executive Officers and decision-makers?
Telephone Number
E-mail Address
Address
Post Code
Please Answer the following for each activity requiring cover
Activity One
1. Activity Name:
2. Are you fully qualified?	YesNo If no please pass on to Q4
3. Please confirm the date you first became qualified?	Please move next to Q5
4. When did your training course commence?	And when is it scheduled to complete?
5. What training programme/s have you undertaken (are undertaking)? Please provide details of Qualification/ certificate/diploma.
6. How many contact hours does the course involve?
7. Is your Qualification externally accredited?	YesNo If so, by who?
Click Here For Activity Two
1. Activity Name:
2. Are you fully qualified?	YesNo If no please pass on to Q4
3. Please confirm the date you first became qualified?	Please move next to Q5
4. When did your training course commence?	And when is it scheduled to complete?
5. What training programme/s have you undertaken (are undertaking)? Please provide details of Qualification/ certificate/diploma.
6. How many contact hours does the course involve?
7. Is your Qualification externally accredited?	YesNo If so, by who?
Click Here For Activity Three
1. Activity Name:
2. Are you fully qualified?	YesNo If no please pass on to Q4
3. Please confirm the date you first became qualified?	Please move next to Q5
4. When did your training course commence?	And when is it scheduled to complete?
5. What training programme/s have you undertaken (are undertaking)? Please provide details of Qualification/ certificate/diploma.
6. How many contact hours does the course involve?
7. Is your Qualification externally accredited?	YesNo If so, by who?
Additional information
I confirm I have read and understood the Terms of Business Agreement. Terms of Business Agreement

Please only complete & submit the following details if you are applying for a quotation in your individual name.

Please Answer the following for each activity requiring cover