Commercial Insurance Quotation Form Click here for Print Version of form

1. Details

Contact Name: Proposer: Risk Address: Telephone No: Business Description 2. Property Buildings: € Stock: € Machinery, Fixtures and Fittings: € Contents: € Tenants Improvements: € 3. Money On the insured premises during working hours € In Locked Safe € 4. Employers Liability Wage Roll: € Directors: € Clerical / Administration: € All other employees: € 5. Public / Products Liability Turnover: € Limit of Indermnity : € Work away Wages: € 6. Consequential Loss Gross Profit € Period of Indemnity Months 7. Computer Insurance Computer Equipment Hardware € Software € 8. General How long in Business? 5 years Claims experience Current Insurer Present Premium € Renewal Date 9. Construction Construction: Roof: Walls: Floor: Age of Building: 10. Security Alarm: Linked: Other Occupancy: Name Date: 11. Other Covers Do you require a quote for?       Directors and Office Liability Credit Insurance   Employers Practice Liability Marine and Goods in Transit   Corporate Legal Liability Engineering   Pensions Trustee Liability Motor   Professional Indemnity Personal Accident