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LIABILITY INSURANCE QUOTE
This form only takes a few minutes to fill in. We aim to send you a quote via email within 24hrs.
If you would like immediate cover or would prefer to answer these questions over the phone, the number to call is FREEPHONE: 08714 230 200.
 Address & Contact Details
From what date do you wish your insurance cover to start ?
Title

First Name

Surname

Company or Trading Name

Business Address

Postcode

Contact Telephone Number

Email

Description of trade or business

How many employees do you have?

Clerical Manual

How many years have you been in business?

 Public Liability
Is this cover required?   Yes   No

Indemnity limit required? 

   
 Employers Liability
Is this cover required?   Yes   No
Estimated annual wages, salaries and other earnings for the coming year

Description of all employees

Estimate (£) Number of persons
Clerical and non manual work    
Work overseas, offshore or on ships    
Woodworking machinists    
Work carried out at a height of more than 10 metres above ground or floor level    
For all other manual work please complete below and describe duties
Duties Estimate (£) Number of persons

 

   

 

   
and for working Partners/Proprietors

Description of work

Estimate (£)

Number of persons

 

 

 

 

 

 

Has there been any incidents in the last five years which have, or could have given rise to any claims under this section?   Yes   No
if yes, please give full details in the box below including dates, details of claims, any monies paid and outstanding
 
About Wages
(state estimated annual payments of wages, salaries and other earnings)
Estimate (£)

Number of persons

Work at own premises  

 

Work undertaken away from your own premises  

 

Please describe the nature of any such work, if none, state 'none'

 
Do you engage in work at high risk premises involving the use of heat?   Yes   No
Work at high risk premises not involving the use of heat?   Yes   No
Work at non high risk premises involving the use of heat?   Yes   No
Work at non high risk premises not involving the use of heat?   Yes   No
 Tools Cover
Is this cover required?   Yes   No

Please describe 

 
Please provide details if you are involved in any hazardous work such as with explosives, toxic chemicals, demolition, below ground, underwater, heights above 15 meters, etc

 

   

Thank you for filling in this form
     

PROFILE INSURANCE SERVICES:  52 HIGH STREET, IRCHESTER, NORTHAMPTONSHIRE NN29 7AB
 Telephone: 08714 230200      Fax: 08714230221      Email: profileinsurance@btconnect.com
Profile is an independent intermediary acting for over 40 insurers
  Authorised and regulated by the Financial Services Authority . Firm Ref 300093