Application form for Approved Sub Contractors

Company Name: *

Address *

Post Code: *

Telephone Number: *

Contact Name: *

Contact Mobile No: *

Contact Email: *

Companies House No: *

VAT Registration No:

Service / Area Covered

Type Of Business: *

Areas Covered: *

Bank Account Details

Bank Name: *

Bank Branch: *

Bank Account Name: *

Bank Sort Code: *

Bank Account Number: *

Health & Safety Management

	Yes	No
Do you have a Health & Safety Policy ?
Health & Safety Policy attached ?
Do you have Public Lability Insurance ?
Public lability Insurance Certificate Attached
Do you have Employees Lability insurance ?
Employees Liability Insurance Certificate Attached ?
Do you maintain accident records ?
Do you investigate accidents ?
How many RIDDOR accidents have you had in the last 3 years ?
Do you formally monitor H&S procedures ?
Do you hold any H&S Accreditation's ?
H&S accreditation's attached ?
Do you monitor sub contractor Incumbent controls ?
Are your staff fully trained in the task they are required to perform such as gas safe ?
Governing body certificates attached?
Do you carry the insurance for the activities you undertake?

Please ensure all copies of documentation, certificates etc for review with this questionnaire. Relevant Insurances held with a minimum of 5M coverage (e.g. Employers Liability, Public Liability & Professional Indemnity)

Confirmation

To be signed by an Authorised Representatives of the Supplier

I Confirm that all of the information provided above is true & accurate and I consent computer for the purpose of processing payments

Signature: *

Name: *

Position Held: *

Date: *

Attachment

ABML Office Use Only:

	Yes	No
Health & Safety Policy Included
Public Liability Insurance Certificate Checked
Employees lability Insurance Certificate Checked
H&S Accreditation's Checked
Governing Body Certificates Checked

ABML Sub Con Appointment Check

Signature: *

Name: *

Position Held: *

Appointment Date: *

Review Date: *

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