Liability Insurance Quotation - Public and Employers liabilty Insurance. Online quote form.

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Liability Insurance Quotation

To help us provide you with out best possible quotation, please complete as much of the following liability quotation form as you can.

Title
Name
Trading Name
Address
Address 2
Address 3
Address 4
Postcode
Telephone
Email
Occupation/Trade
Years Trading
Claims/Losses in the last five years
Public Liability
Employers Liability

In order to calculate the premiums for the Liability sections we will require the following information

Number of principals / partners (manual work)
Number of principals / partners (non-manual work)
Number of directors (manual work)
Number of directors (non manual work)
Number of employees (manual work)
Number of employees (non manual work)
Number of Labour only Sub-contractors
Number of principals / employees working away from premises
Projected Annual Turnover
Projected Annual Wages (manual)
Projected Annual Wages (clerical)
Maximum External Height Worked	Meters
Maximum Internal Height Worked	Meters
Any heat application:-	None - Blowlamps - Welding - Gas Cutting
Ever been declared bankrupt or insolvent?
Been convicted of any criminal offence, which is not 'Spent'?
Had any County Court Judgements entered in the last six years?

WestPennine Insurance Services Group is the trading name of WestPennine Insurance Consultants Limited. Registered Office 84 Church Street, Littleborough. OL15 8AU. Registered in England number 939318
Telephone 01706 378990 Fax 01706 371417

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