Quote Form

Business Activity*

What is your estimated turnover for the upcoming 12 months?*

What limit of Public Liability Insurance do you require?*

Do you require buildings cover?*

Yes

If Yes, enter cover amount

Do you require contents cover?*

Yes

If Yes, enter cover amount

Do you require commercial vehicle insurance?*

Yes

If Yes, enter insurance amount

How many employees do you have?*

Has anyone with control over or a financial interest in your business (including you, family or any partner, principcpal or director), ever had a previous policy canclled, refused or voided?

Yes

If Yes, please define

Has anyone with cover or a financial interest in your business (including you, family or any parnter, principal, director) ever been declared bankrupt, entered into an IVA or been subject to any County Court Judgements?

Yes

If Yes, please select

Has anyone with control over or a financial interest in the business, (including you, your family or any partner, principal, director) ever been a director of a company which went into liquidation?

Yes

If Yes, please define

Has anyone with control or a financial interest in the business (including you, your family or any partner, principal or director), been convicted or charged with a Criminal Offence that remains unspent under the Rehabilitation of Offenders Act 1974?

Yes

If Yes, please define

Would you like to provide any additional details which you feel may be relevant to proposal or help us provide a quotation?

We would Be Happy To Assist You

Business Insurance Form