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Company Name
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Statement of Fact
General
Within the past 10 years, myself or any of the directors, partners or other board members, or any entities for which such persons act or acted as board members, have not been the subject of any insolvency process.
None of our directors, partners or other board members ever been:
i)disqualified from acting as a director of a limited company or member of a limited liability partnership; or
ii)convicted of or charged with a criminal offence, other than a conviction spent under the Rehabilitation of Offenders Act 1974?
I have never had any insurance policy avoided or cancelled.
Thinking about our current business, or others I have run in the past: I am not aware of any circumstance or incident that may give rise to a loss or a claim being made against us.
No past or present director, partner, principal or manager has ever suffered any claim, loss or damage that would fall within the scope of the proposed insurance.
I confirm that retroactive cover is not required.
I confirm that we do not undertake, supervise, host, co-ordinate, organise or facilitate in any respect whatsoever any of the following activities:
i)taking any swab samples or other testing designed to provide, or help to provide, a positive or negative diagnosis for COVID-19, other than where this is for our employees, clients or ii)customers for the purposes of carrying out our primary trade, business or profession; or supplying or administering any vaccination for COVID-19, other than where this is for our iii)employees for the purposes of carrying out our primary trade, business or profession.
We do not undertake or supervise any manual work, other than collection or delivery.
We do not sell, supply, manufacture, install, repair or service any products.
We do not host, coordinate or organise any events.
I/we am/are a UK residents/businesses.
Our wageroll does not exceed £ 150,000.00 annually.
We do not make TV commercials or work to the APA contract.
We do not produce programmes for mainstream terrestrial broadcast.
We do not produce motion picture/feature film/mainstream theatrical release productions.
Where we use sub-contractor companies (this does not apply to freelance crew) they must carry own insurance.
We are not involved with hazardous filming (pyrotechnics/stunts/heights over 5m/watercraft/high speed vehicles/aircraft/animals).
We do not undertake set building.
We do not undertake rigging.
Single contract value not exceeding £50,000.00 (a + b) or £100,000.00.
We do not work in the US.
We have had no claims in the past 5 years or no more than one claim in excess of £1,000.
I have read the Statement of Fact
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