Public Liability Insurance Quotation


Full Name:
Company Name:
Company Status:
House Number/Name (Home):
Home Postcode:
Email Address:
Home Phone:
Mobile Phone:

Date of Birth :
Marital Status:
Occupation/Business:
Trading Address:
Trading Postcode:
Required Start Date Of Cover :
How many years has this business been trading?:
How many years experience do you have this in trade?:
Best quote so far?:
Where Is That Quote From?:
Have you made any claims or suffered any losses in the past 5 years?:
Estimated annual turnover (£):
How many premises do you operate from?:
Have you or you business partner/company director ever been declared bankrupt?:
Had a company go into liquidation or become insolvent?:
Been convicted or have any prosecutions pending or been given an official police caution, in respect of any criminal offence other than motoring offence?:
Had any insurance proposal declined, renewal refused, had any special or increased terms applied or had insurance cancelled mid-term by underwriters?:
Public liability limit of indemnity:
Number of proprietors/directors doing manual work:
Number of employees doing manual work:
Number of employees/directors/proprietors doing clerical work:
Estimated annual payments to bona fide subcontractors £ :
Do you work over 15 metres in height?:
Maximum depth worked at?:
Does your work involve the use of heat?
Do you work solely on private dwelling homes, shops, offices, public houses & guesthouses?:
Best Time To Contact You?: