Employers' liability insurers notification template

This notification must be made in accordance with ICOBS 8.4.6R. If this template is used to notify us of a new position under ICOBS 8.4.11R(1) please complete all fields including those that have not changed.

All insurers (including EEA insurers passporting in) and Lloyd's managing agents managing syndicates with permission to conduct general insurance business in the UK are required to notify us of the following:

1. Firm name

2. Firm Reference Number (FRN):

3. Does the firm, or a member of a syndicate it manages, carry on business falling within ICOBS 8.4.4R(1) i.e. does it have actual or potential liability for UK commercial lines employers" liability insurance, whenever written?:

Yes

4. The website address of the firm or tracing office where the employers" liability register required under ICOBS 8.4.4R is made available:

5a. The name of a contact person at the firm:

5b. Contact person telephone number:

5c. Contact person address:

6a. The period start date at which the firm, or members of syndicates it manages, provided cover under relevant policies:

6b. If it is no longer continuing, the end date of the cover:

7a. Do you write employers liability excess policies?

Yes

7b. If yes, have you excluded them under ICOBS 8 Annex 1.1B?

Yes

Declaration: To the best of my knowledge, the content of this notification is true and accurate.

Yes

This notification must be authorised by the director of the firm.

Director"s Name:

Date notification completed:

First published: 16/05/2016 Last updated: 09/12/2016