#
# HOME # ABOUT US # REGISTER # PRESS RELEASES # CONTACT US #
This Website is Intended for Intermediary Use Only.
#
COMMERCIAL QUOTATION ENQUIRY FORM
 #
#
General Times
# # # # #
Fields marked with an asterisk * are required
Date:*
BROKER DETAILS
Broker Name:*
 		 Broker Telephone Number:*
 
Broker Email Address:*
    		Broker Fax Number:
QUOTE TYPE
Shop: Office:
Commercial Property Owners: Public & Employers Liability:
Pub/Restaurant: Other:
CLIENT DETAILS
Client Name:*
 
COMPANY TRADING NAME(If Applicable)
LTD Company?:*
  		Started Trading:*
 
Business Description:*
 
RISK ADDRESS
1st Line of Address: 2nd Line of Address:
3nd Line of Address: Post Code:
CORRESPONDANCE ADDRESS(If Different)
1st Line of Address: 2nd Line of Address:
3nd Line of Address: Post Code:
Contact Numbers:*
 
Property Type:*
 		 Year Of Build:
Does The Client Own Or Lease The Premises:*
 		    
Is The Property Let Out Or Occupied By The Client:*
 		    
Is The Property Standard Construction?*
 		    
Number Of Employees:      
Manual:*
 		 Clerical:*
 
Turnover:*
 		 Wageroll:*
 
SUMS INSURED REQUIRED
Buildings: Or Tenants Improvements:
General Contents: Stock:
Fixtures & Fittings: Computers Sum Insured:
Public Liability: Standard (£2M) or Other:*
 
Employers Liability is standard at: £10M
PREMISES SECURITY
Alarm:*   (If Yes State:Make,Model & Policy Response)
 
Shutters:*
 		 Bars On Accessssible Windows:*
 
Mortice Deadlocks:*
 
CLIENTS CURRENT INSURERS
Any Previous Claims:*   (If Yes State:Name,Date,Reason & Claim Amount Below)
 
If you have any further information regarding this quotation request, please provide additional information in the box below.
The information contained in this website is intended for intermediary use only. If you do not have professional experience you should not rely on it. 		#
# # #