Free no-obligation quote form...

Please complete the details as fully as possible
- the more info usually means a better rate.

Please input OBIS broker name:


Client Name:


Risk Address - INCLUDE POSTCODE:


Type of enquiry:
New Business Existing Business Other


Existing Insurers / underwriters:


Renewal Date
Please Choose Need Immediate Renewal within 7 days Renewal within 14 days Renewal 14 days upwards


Trade / Business - DETAIL AS MUCH AS POSSIBLE


Work Away From Premises:
Please Choose No Yes

Export / Work outside of UK:
Please Choose No Yes

Years Trading
Please Choose New Venture 1 year 2 years 3 years 4 years 5 or more years

Premises
Please Choose Standard Construction - Brick & Tile Standard Construction - Brick & Slate Non Standard - Brick & Flat Felt Non Standard Other

Alarmed
Please Choose Bell only - No Nacoss Nacoss - Redcare Digicom None

Fire
Please Choose Extinguishers and alarms Sprinklers

Claims Details
Give ALL claims in last 5 yrs inc date and circumstance

Sum Insured & Covers:

Existing Insurers / underwriters

Buildings                                

Contents / Machinery               

Stock                                     

Wines & Spirits                       

Frozen Foods                          

Computers                             

All risks sum insured               

BI Sum Insured                      

BI Indemnity Period                

Cash (Transit & Premises)       

Public Liability                         

Turnover (£)                          

No of employees or wages      

Further information                 

Further information regarding risk for consideration:


Target Premium to Beat:        


Please contact me as soon as possible regarding this risk.