Commercial Insurance Quote Form

Your Name:
Company Name:
Address:
Business Description:
Tel Number:
E-mail:

Employee Information

  No. Of Employees Wage Roll Figures
Directors: £
Clerical: £
Direct Employees: £
Sub-contractors: £

Insurance Required for

Employers' Liability: Yes No
Public Liability:

Contractors All Risks: Yes No
Professional Indemnity: Yes No
Buildings and Contents: Yes No
Fleet Insurance: Yes No

Current Insurer Information

Company Name:
Renewal Date:

Have you made a claim in the last 5 years?: Yes No

If you have claimed or would like to add further information provide details:

Target Premium: £