Quote4Insurance
Liability Quotation Request
Section 1 - Your Full Name & Address
Title
Mr.
Mrs.
Miss
Dr.
Rev.
First Names
Surname
Address
Town
City
County
Postcode
Telephone
Email
Section 2 - Business Details
Address
Town
City
Postcode
Comments where applicable, any heights worked at, use of the heat, depth limits, etc.
Work Away from Premises
Type of Premises worked At
Section 3 - Indemnity Limit
Employers Liability
Public/Products Liability
Section 4 -
Employees (Number and Wageroll required)
Clerical
Manual (Premises)
Manual (Work Away)
Principals Own Drawings Figure
Section 5 -
Payments to Sub - Contractors
Labour Only
Bona Fide
Turnover
Claims History
How did you hear of
Quote4insurance
?
e.g. Name of magazine/newspaper you saw our advert in, T.V., radio, Teletext,diverted from other site = please name site / search engine, internet advert etc.