nannyinsure application form

About You Title First Name Last Name Date of Birth (dd/mm/yy) Nationality

Contact Details Email address Contact telephone (preferably your mobile)

Permanent Address Address Line 1 Address Line 2 [optional] City County Postcode

Work Address Address Line 1 Address Line 2 [optional] City County Postcode

Coverage Details Insurance Start Date (dd/mm/yyyy) Cover required

Your work environment Hours Worked per Week hours (or variable hours )

Please provide details of your irregular work pattern

Number of Children in your care Will any of the children require ongoing medical attention?

Please provide details

Your work history Details of experience and qualifications Are you intending to become Ofsted registered? Have you had a Criminal Records Bureau check for childcare? Have you ever had nanny Public Liability insurance before?

Please provide Insurer and Period of Cover details

Have you ever been refused nanny Public Liability insurance before?

Please provide details

Have you been convicted of any criminal offence (including motoring) or have any prosecutions pending?

Please provide details

Have you ever been the subject of a claim, or know of any incidents that could give rise to a claim?

Please provide details

How did you find us ? How did you hear about Nannyinsure?

Please note: Cover does not commence until you receive formal confirmation from Nannyinsure.

I have read and accept the Terms and Conditions (opens in a new window) and Terms of Business Agreement (opens in a new window) for this policy.

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