Business Insurance Form

To obtain a quotation, please fill in the form below
Sections marked with an asterisk " * " are compulsory fields

CUSTOMERS FROM THE REPUBLIC OF IRELAND:
please click here for more appropriate forms and further information on our range of insurance products available in the Republic of Ireland.

Your Details.

1. Private individual or company?*
2. Company name*
3. Contact title*
4. Contact name*
5. Company address line 1*
6. Post code*
7. Telephone number*
8. Mobile number
9. E-mail address*
10. Web address
11. Type/s of cover





























12. Business description
13. Projected annual turnover?
14. Preferred contact method

QUOTATION ASSUMPTIONS

In order to provide a quotation please read the following:

An insurance company has never:

  • cancelled one of your policies
  • applied special terms when renewing your policy
  • refused to give you a policy
  • refused to renew your policy

And

  • You have never been declared bankrupt, had a company go into liquidation or become insolvent
  • You, or any business partner or director have never had any convictions, other than motoring offences
  • No work is to be undertaken outside, Great Britain, Northern Ireland, channel Islands and the Isle of Man
  • No work is to be undertaken in or on aircraft installations, nuclear installations, petro chemical works, power stations or offshore
  • Payments to temporary employees or bona fide subcontractors do not exceed 25 per cent of the proposed annual turnover.
  • No work is to be undertaken at a height greater than 5 metres or below a depth limit of 1 metre.
15. I agree*