Business Liability Insurance - Quotation Form

To obtain your quotation please submit the on-line form below * = required field

1. Company Information

Contact Name: * Company Name: Nature of Business: Address 1: Address 2: Address 3: Town: County: Postcode: Telephone: * Fax: E-mail: *

2. Total income for the last complete financial year

£

3. Estimated Annual Turnover

£

4. Number of partners, directors and employees

How many involved in manual duties

5. Total number of permanent employees (do not include partners)

How many employees involved in administrative duties

6. Public Liability Limit required (we will automatically quote for £10m limit for employer's liability)

£1 Million £2 Million £5 Million

7. Any claims in the last 5 years?

Yes No If so please give details:

Our quotation will assume the following:

1. Annual payments to temporary employees will not exceed 25% of annual wage roll   2. Annual payments to labour only subcontractors will not exceed 25% of annual wage roll

If you experience problems with the on-line quotation form please contact us

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