Address Details

Indemnitas
23 Cromwell Road
Rugby
Warwickshire
CV22 5LP

Telephone
0845 686 0264

Facsimile
0845 686 0262

Email claire@cobrarugby.co.uk

 

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Need Help? Speak to us on 0845 686 0264

 

DETAILS :
  Name of Practice: * *
  Address:
  Postcode:
  Tel Number: * *
  Website:
  Email: * *
  Establishment Date:
  Number of directors/partners:
  Number of all other staff:
  Please select your profession from the following list:

Accountancy
  Please give your fees applicable for your last 12 months trading:
(or anticipated income if new business)
Please provide an approximate percentage split of your fee income in the following:
  Accounting and compliance taxation – quoted/public
companies		 %
  Accounting and compliance taxation – other %
  Auditing – quoted/public companies %
  Auditing – other %
  Bookkeeping %
  Directorship %
  Executorships and Trustees %
  Insolvencies, Liquidation and Receiverships %
  Insurance, Building Society, Stock Exchange/Investment
Commission		 %
  IT Consultancy %
  Management Consultancy %
  Mergers, Acquisitions, Disposals %
  Taxation (consultancy only) %
  Payroll Services %
  Secretarial and Share Registration %
  If others please describe:

Design & Construct
  Please give your turnover applicable for your last 12 months trading:
(or anticipated income if new business)
Working Environment
Please provide an approximate percentage split of your turnover income in the following:
  Bridges %
  Dams %
  Mines %
  Harbours or Jetties %
  Sewage Schemes %
  Foundations and Underpinning %
  Water Schemes %
  Nuclear or Atomic Projects %
  Chemical, Petro-Chemical and Refineries %
  Housing Schemes (2-3 floors) %
  High Rise Buildings %
  Schools, Hospitals, Municipal Buildings %
  Commercial / Industrial Systems Buildings %
  Merchant Plant and Bulk Handling Equipment %
  Leisure Centres %
  Swimming Pools %
  Churches / Ecclesiastical %
  Roads / Highways / Motorways %
  Cladding / Glazing / Curtain Walling %
  Roofing %
  Airports %
  Railways %
  Amusement Parks %
  Aviation / Automotive / Military / Marine %
  Demolition %
  Flooring %
  If others please describe:
 
Type of Work Design and Build Only Design Only
  Adjudicator/Arbitrator % %
  Architectural Services as Defined in Work Stages
C-L of RIBA Architects Appointment		 % %
  Building Surveying % %
  Consultancy Engineering – Civil % %
  Consultancy Engineering – Structural % %
  Consultancy Engineering - Environmental % %
  Consultancy Engineering - Geotechnical % %
  Consultancy Engineering – Mechanical % %
  Consultancy Engineering – Electrical % %
  Consultancy Engineering – Heating & Ventilation % %
  Expert Witness % %
  Feasibility Studies % %
  Interior Design % %
  Landscape % %
  Non Structural Refurbishment % %
  Town Planning / Consultancy % %
  Planning Supervisor % %
  Project Co-ordinator % %
  Project Management % %
  Quantity Surveying and Surveying (not listed above)   % %
  Structural Surveys/Reports/Valuations % %
  If others please describe:
 
  Financial Year Status Previous Last Complete Current (Estimate)
  Financial Year End (dd/mm/yy)
  Turnover where the firm(s) design & constructs
from their own design and provides full technical supervision
  Turnover of those departments where the firm(s)
providesdesign & technical services where no
construction isinvolved by firm(s)
  Turnover where the firm(s) constructs from other
designs preformed on behalf of firm(s)
  Turnover where firm(s) constructs from other’s
designand technical supervision preformed on
behalf of the firm(s)
  Other turnover not mentioned

Engineer
  Please give your fees applicable for your last 12 months trading:
(or anticipated income if new business)
Please provide an approximate percentage split of your work carried out:
  Bridges %
  Dams %
  Mines %
  Harbours or Jetties %
  Sewage Schemes %
  Foundations and Underpinning %
  Water Schemes %
  Nuclear or Atomic Projects %
  Chemical, Petro-Chemical and Refineries %
  Housing Schemes (2-3 floors) %
  High Rise Buildings %
  Schools, Hospitals, Municipal buildings %
  Commercial / Industrial Systems Buildings %
  Merchant Plant and Bulk Handling Equipment %
  Leisure Centers %
  Swimming Pools %
  Churches / Ecclesiastical %
  Roads / Highways / Motorways %
  Cladding / Glazing / Curtain Walling %
  Roofing %
  Airports %
  Railways %
  Amusement Parks %
  Aviation / Automotive / Military / Marine %
  Demolition %
  Flooring %
  If others please describe:
Please give the split of gross fees recieved in the last complete financial year:
   
United Kingdom
Overseas Contracts
  Consulting Engineering
  Civil
  Structural
  Soil & Foundation
  Mechanical
  Electrical
  Heating & Ventilation
  Architectural
  Town Planning / Quantity Surveying
  Structural Surveying Inspection Reports
  Valutations on Existing Property
  Planning Supervision
  Adjudication / Arbitrator
  Expert Witness
  Any work other than listed above,
please give full details:

Estate Agents
  Please give your fees applicable for your last 12 months trading:
(or anticipated income if new business)
Please provide an approximate percentage split of your fee income in the following:
  Estate Agency including Probate, Matrimonial & Market
Appraisal		 %
  Management Letting's – Residential Properties %
  Management Letting's – Commercial Properties %
  If others please describe:

Financial Advisor
  Please give your fees applicable for your last 12 months trading:
(or anticipated income if new business)
Please provide an approximate percentage split of your fee income in the following:
  Pensions %
  Endowments %
  Other Life %
  Mortgages %
  Building Society Agencies %
  PHI Medical %
  Private Client Portfolio Management (Discretionary) %
  Private Client Portfolio Management (Non-Discretionary) %
  Investment In Unit Trusts / Insurance Bonds %
  Dealing in Listed, Unlisted UK or Foreign Securities %
  Dealing in Bonds (e.g. Euro Dollar) or Commodities %
  Structured Capital at Risk Products %
  Split Capital Investment Trusts / Zero Dividend
Preference Shares		 %
  Income Drawdowns %
  If others please describe:

Insurance Broker
  Please give your fees applicable for your last 12 months trading:
(or anticipated income if new business)
Please provide an approximate percentage split of your fee income in the following:
  Personal Lines %
  Commercial Lines %
  Professional Indemnity %
  Construction %
  Aviation %
  Marine %
  Risk Management / Consultancy %
  If others please describe:

IT Consultants
  Please give your fees applicable for your last 12 months trading:
(or anticipated income if new business)
Please provide an approximate percentage split of your fee income in the following:
  Hardware Sales %
  Hardware Installation / Maintenance %
  Software Product Sales %
  Software Services %
  Internet Services %
  If others please describe:

Management Consultants
  Please give your fees applicable for your last 12 months trading:
(or anticipated income if new business)
Please provide an approximate percentage split of your fee income in the following:
  Strategic Consultants %
  Organisation, Design & Development Consultancy %
  Quality Management %
  Manufacturing Systems Consultancy %
  Financial Management – Consultant only %
  Project Management %
  Human Resources Consultancy %
  Recruitment Consultancy (Permanent Staff) %
  Recruitment Consultancy (Temporary Staff) %
  Marketing Consultancy %
  Telecommunications Consultancy %
  Computer & IT Consultancy %
  Outsourcing & Facilities Management Consultancy %
  Design & Creativity Consultancy %
  Quality Assurance Consultancy %
  Health & Safety Consultancy %
  Interim / Locum Management %
  Training Services %
  If others please describe:

Marketing & Media
  Please give your fees applicable for your last 12 months trading:
(or anticipated income if new business)
Please provide an approximate percentage split of your fee income in the following:
  Commercial TV – Production of Advertisements %
  Commercial TV – Media Space Purchased %
  Other Media – Production of Advertisements %
  Other Media – Media Space Purchased %
  Production of Printed Literature/Documents %
  Direct Marketing %
  Telemarketing %
  List Broking %
  Sales Promotion %
  Marketing %
  Market Research %
  Public Relations %
  Specialist Design %
  Corporate Identity Work %
  Event/Conference Organisation %
  Multimedia Consultancy %
  If others please describe:

Recruitment Consultant

  Please give your fees applicable for your last 12 months trading:
(or anticipated income if new business)
Please provide an approximate percentage split of your fee income in the following:
  Clerical IT %
  Other Professionals %
  Medical/Nursing/Care %
  Drivers/Warehouseman %
  Blue Collar / Manufacturing %
  Construction Manual %
  If others please describe:
 

Any Other Miscellaneous Professions
  Please give your fees applicable for your last 12 months trading:
(or anticipated income if new business)
  Please give details of your full business activities with
approximate work splits in percentages:

Claims History
Have you had any claims in the past 5 years?
If Yes, please provide full details of all claims:
Additional Information
Please state any other additional information that
you would like to make us aware of:
   
 
 
 
Indemnitas. All rights reserved. COBRA Insurance Brokers Ltd (Rugby Branch, 23 Cromwell Road, Rugby, Warwickshire, CV22 5LP is authorised and regulated by the Financial Services Authority. Our FSA Register number is 138302