Public Liability Enquiry

Please complete the enquiry form below to receive a quotation for your liability insurance. We will contact you, with your quotation, by telephone, email, post or fax, please select your preference on the form. When you have completed the form, press the "Submit Details" button to proceed.

We aim to provide a fast response to your enquiry and will endeavour to acknowledge receipt of your enquiry the same day.

Please try to complete all details as omissions may affect the given quote. Before completing the form please read the Terms of Business. If you have any queries please contact us.

Please select your business activity from the options provided:

Proposer / Company Details:

Status

Name

Address

Post Code

Telephone Number

Mobile Number

Fax Number

E-mail Address

Renewal Date

Current Insurer

Target Premium

How many years have you been trading?

Have you made any claims or suffered any losses in the past 5 years?

If yes, please provide full details including dates, costs and circumstances.

Liability Cover:

Public Liability Indemnity Level

Employers Liability

Number of manual employees including working directors and labour only sub-contractors

Number of non manual employees including directors

Estimated annual payments to bona fide sub-contractors?

Do you work solely on private dwelling houses, offices, public houses, guest houses, hotels and schools?

Please select the maximum height at which you work

Please select the maximum depth at which you work

Does your work involve the application of heat?

If other, please give full details

STATEMENT OF FACT

You do not work with silica, asbestos, or substances containing asbestos.
You do not work with acids, gases, explosives, radioactive, or similar
dangerous liquids.
You do not do any work on power stations, nuclear installations,
or establishments.
You do not do any work on refineries, bulk storage, or premises in oil gas
or chemical industries, or offshore structures.
You do not do any work on aircraft, hovercraft aerospace systems,
watercraft, railways, underground, or underwater.
You do not do any work in or on computer suites or on computers.
You do not use any fixed powered woodworking machinery.
You have no adverse insurance, or personal history.
There are no other material facts that may affect an insurers willingness
to offer you cover.

If you agree with the above Statement of Fact, please confirm here by checking the box

If you do not agree with the above Statement of Fact, please provide full details below.

Preferred Method Of Contact

Enquiry Source