Liability Insurance Quote Form

Quote Form

Liability Insurance Quote Request Form

Please complete the form below. We will pass your request to one of our panel of liability insurance brokers who will provide you with a public liability insurance quote within 24 hours.

Your contact details

Name
Title
Company Name
Date Established
Business address
E-mail address
Phone Number

Best Contact Time

About your company

Manual employees	1 2 3 4 5 6 7 8 9 10
Clerical employees	1 2 3 4 5 6 7 8 9 10
Annual turn over
Trade/Occupation

Please include directors in the appropriate employee category. Partners or sole traders should only be included if they undertake manual work and should be entered in the manual employee category. If your trade or occupation is not shown above please provide a full description of your trade or occupation in the comments section at the end of this form.

About the insurance you need

Public liability	£1M £2M £5M
Employers liability	Yes No
Tools of trade	Yes No

Declaration

I/we have not had more than 2 claims or losses in the last three years exceeding £1000 in aggregate.

I/we have never had a proposal or renewal declined, withdrawn or subject to increased terms.

I/we do not make payments to temporary employees and sub contractors in excess of 25% of annual turnover.

I/we agree	Yes No
Comments

Remember our service guarantees you

	Lowest public, employer & product liability insurance quotes from leading UK insurance company's & Lloyds of London
	Independent advice available on all types of liability insurance from our panel of brokers including high risk & difficult to place risks
	Flexible payment facilities, including cheque, credit card and monthly payment plans

[ Home ]

Please note liability-insurance-quote.co.uk is not authorised by the Financial Services Authority; it simply acts as an introducer representative to a number of liability insurance specialists.

Liability Insurance Quote Request Form

Remember our service guarantees you

Questions or comments about this web site: mail@liability-insurance-quote.co.uk Copyright © 2006 liability-insurance-quote.co.uk.

Please note liability-insurance-quote.co.uk is not authorised by the Financial Services Authority; it simply acts as an introducer representative to a number of liability insurance specialists.