This is an important document and you must read it in full

A statement of fact records the information notified to Aviva and facts assumed about you, your business and your business partners and directors. The information within it is taken into account when calculating the premium, terms and conditions upon which your policy is based.

All material facts must be disclosed. Failure to do so could invalidate the policy. A material fact is one which is likely to influence an insurer in the acceptance and assessment of this application. If you are in any doubt as to whether a fact is material then it should be disclosed to us. If any changes in circumstances arise during the period of insurance cover please provide us with details.

We recommend you keep a record (including copies of letters) of all information provided to us for your future reference. A copy of all information given to us can be supplied on request within a period of three months.

Any subsequent alterations to this statement of fact takes precedent over the information contained within it.

General Information

Limited Company Limited Partnership Partnership Sole Proprietor

Activities and Turnover Details (Part 1/3)

Put in your estimated turnover for the next 12 months.
Annual Turnover (£) *

Please fill out the % first, the table will then fill in the turnover split for you.

Split by activity Percentage (%) Turnover Split
Arboriculture (Height Work Above 10m)
Arboriculture (Height Work Below 10m)
Arboriculture (Ground Work)
Landscaping/Garden Maintenance
Forestry Manual e.g. chainsaw
Forestry Mechanical
Work at hazardous locations; e.g. petrochemical stations/motorway vegetation clearance etc
Manual work overseas
Rail track Arboriculture/Clearance*
Airside Arboriculture Clearance
Sale of Plant / Equipment
Hiring OUT of Plant / Equipment
Other - please provide further details of other work

Wages/Labour Only Sub Contractor Payments (Part 2/3)

Yes No

Please advise number of and total estimated amount payments in each category.

Also please give approximate % for any activity (if above 10%)

Category Number of Workers Total Payment £ Split of Activity within each category
Principals/Directors Clerical % Ground/Landscaping %
Under 10m % Over 10m %
Forestry % Consulting %
Other %

Contractors (Part 3/3)

Yes No

Contractors All Risks

Yes No

Plant Cover

Yes No

Employees Tools

Yes No

Hired in Plant

Yes No

Professional Indemnity

Yes No


Please provide details of security at own premises.

Details of locks fitted to doors
Are locks fitted to all accessible opening windows?
Are bars/lockable grills/shutters on ALL accessible windows & doors
Is security lighting operational at night
Is property in area protected by CCTV
Is there an intruder alarm fitted & in working order?
Please provide details of the security arrangements made for plant left overnight on site
Yes No

Health & Safety

Does everybody working for the business have relevant professional qualifications?*
Have all required risk assessments been carried out and recorded?*
Do you provide Health & Safety training to employees and contractors working for you and keep a record of this where applicable?*
Do you supply and enforce use of Personal Protective Equipment where required?*
Do you undertake precautions and controls for the identification of underground pipes, cables or other services which could be at risk or under the site and keep a record of this?*
If you use bona fide subcontractors do you check that they have Public Liability Insurance to a limit of £2,000,000 and Employers' Liability Insurance?**
If you are involved in traffic management is all work carried out in accordance with Chapter 8 of the Traffic signs manual by fully qualified personnel?*
If No to any question, please add additional information below;

Claims Experience

Yes No


Have you, your Directors, partners or family members involved with the business or any other business ever:

Had a proposal or insurance declined, cancelled or refused?
Had any special terms or conditions imposed?
Been convicted or charged (but not yet tried) or been given an Official Police Caution, in respect of any criminal offence?
Been the subject of any Country Court Judgements or Sheriff Court Decrees?
Been declared bankrupt or insolvent or been disqualified from being a company director or been involved as owner Director or Partner with any company which went into receivership, administration or liquidation?
Been involved in another company within 6 months before receivership/insolvency?
Any other material facts to disclose?
Information that must be given by the policyholder to the insurance company that would affect the judgement of the underwriter in his assessment of the risk including its terms and pricing. If you are in any doubt as to whether any facts are material, we recommend you advise these, for consideration by the underwriter.
If Yes to any question, please add additional information below;

I/we declare that the answers given are true, full, accurate and complete to the best of my/our knowledge and belief and that any material fact*, which may influence the company has been disclosed. I/we understand that if true full, accurate and complete answers are not given that this insurance may not protect me/us in the event of a claim. I also understand that it is my responsibility to provide complete and accurate information to insurers when i take out the insurance policy, throughout the life of the policy, and when the insurance is renewed.

*A material fact is information that would influence an underwriter in either accepting or declining a risk, and if accepting the risk, the premium to be charged. Essentially if you think that by giving an underwriter some information, it may increase the premium or prevent them from providing insurance cover, then this information is probably material and you must advise us of this. If in doubt you should disclose the information anyway.

Confidentiality & Security

We maintain the highest standards of client confidentiality. We recognise that the nature of our service means that we will often be privy to information of a commercial and personal nature, and under no circumstances will this be shared with any third party unless we are legally obliged to do so. We will take all reasonable steps to ensure that any documents, data and other property or information that we handle or hold for you is held securely.

If you wish to contact a member of our team please either call 0113 259 3560 or email

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