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Please complete the following to begin the Combined Business quote process .....

Name *

 

Name of Contact *

 

Address

 
   

City

 

County

 

Your email address *

 

Retype email address *

 

Phone Number *

 
     

Years in Business

 

Type of Business

 

Current Insurer

 

Current Renewal Date

Select a date  
     
Covers Required    

Property?

type=radio style="font-size= 8pt; height: 20; width:20" name=combproperty value="Y">

YES

type=radio style="font-size= 8pt; height: 20; width:20" name=combproperty value="N">

NO

 

Gross Profit?

type=radio style="font-size= 8pt; height: 20; width:20" name=comblop value="Y">

YES

type=radio style="font-size= 8pt; height: 20; width:20" name=comblop value="N">

NO

 

Employers Liability?

type=radio style="font-size= 8pt; height: 20; width:20" name=combel value="Y">

YES

type=radio style="font-size= 8pt; height: 20; width:20" name=combel value="N">

NO

 

Public / Products Liability?

type=radio style="font-size= 8pt; height: 20; width:20" name=combprod value="Y">

YES

type=radio style="font-size= 8pt; height: 20; width:20" name=combprod value="N">

NO

 

Money?

type=radio style="font-size= 8pt; height: 20; width:20" name=combmoney value="Y">

YES

type=radio style="font-size= 8pt; height: 20; width:20" name=combmoney value="N">

NO

 

Glass?

type=radio style="font-size= 8pt; height: 20; width:20" name=combglass value="Y">

YES

type=radio style="font-size= 8pt; height: 20; width:20" name=combglass value="N">

NO

 
     
Construction    

Wall

 

Floor

 

Roof

 
     
Security               

Alarm?

type=radio style="font-size= 8pt; height: 20; width:20" name=combalarm value="Y">

YES

type=radio style="font-size= 8pt; height: 20; width:20" name=combalarm value="N">

NO

 

If YES, is it connected to a Central Station?

type=radio style="font-size= 8pt; height: 20; width:20" name=combcenalarm value="Y">

YES

type=radio style="font-size= 8pt; height: 20; width:20" name=combcenalarm value="N">

NO

 

Any other relevant details? 

 
     
     
Fire Protection               

Any relevant details? 

 
  (eg. is Fire Alarm connected to Central Station)  
     
Sums Insured Cover    

Buildings ()

 

Fixtures and Fittings / Equipment ()

 

Computers ()

 

General Stock ()

 

Wines and Spirits ()

 

Other (eg. House Contents) ()

 

Fire Brigade ()

 
     
Loss of Profits

12 months

 

Gross Profit ()

 

Increased Cost of Workings ()

 
     
     
Money    

In transit / On Premises ()

 

In safe ()

 

Cash Carryings ()

 
     
     

Employers Liability

   

Limit of Indemnity ()

 

Sales / Clerical / Directors ()

 

Work Away / Installation ()

 

Woodworking ()

 

All Others ()

 
     
     

Public Liability & Products

Liability & Service Indemnity

 

Limit of Indemnity ()

 

Work away Wages ()

 

Application of Heat Wages ()

 

Turnover ()

 

Products Included?

type=radio style="font-size= 8pt; height: 20; width:20" name=combprodincl value="Y">

YES

type=radio style="font-size= 8pt; height: 20; width:20" name=combprodincl value="N">

NO

 
     

Claims in last 5 years

Claims any other business in last 5 years

 

Please review your answers before pressing submit below