Specialists in… Personal Accident, Travel and Liability cover. Liability Quote Submission Form Agent's Email Address Client: StatusSelect valueSole TraderLimited CompanyPartnership Business Description: Postcode: Qualifications: Renewal Date: Years Trading (Experience) LIABILITY - Please indicate cover and Limits of Indemnity Required: Employers Liability (Limit of Indemnity £10,000,000)YesNo Public/Product Liability -£1,000,000 YesNo Public/Product Liability - £2,000,000 YesNo Public/Product Liability - £5,000,000 YesNo Public/Product Liability - £10,000,000YesNo Claims Experience (5 years please):Employers Liability - Please detail numbers and total wages respectively: Employers LiabilityNumbersTotal Wage £Clerical/Non-Manual:Manual:Labour Only Sub-ContractorsBona Fide Sub-Contractors:All Others: Public & Products Liability - Estimated Annual Turnover: £ INFORMATION - Does the insured? Undertake any work outside the United Kingdom or Heat work?*YesNo If using sub-contractors, check that they hold Liability Insurance? *YesNo Operate from own premises?*YesNo Operate from premises owned by other companies?*YesNo Provide overnight accommodation?*YesNo Provide catering facilities?*YesNo Does the insured? - If Yes to any of the above please provide further details:INFORMATION - Has any insurer ever?: Declined to insure?*YesNo Required special terms?*YesNo Cancelled or refused to renew your insurance?*YesNo Has any insurer ever? - If Yes to any of the above please provide further details: Please provide any additional Information below:SubmitReset BrokersAccident & Illness Contractors Liability Tools &/or Business Equipment Travel Login Username Password Forgot your password? Login
