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Quote me now |
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Contact Name |
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Company Name |
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Company Address |
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Telephone |
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Fax |
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Mobile |
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E-mail Address |
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Verify E-mail Address |
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Previous Insurer |
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Renewal date |
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Claims in last 5 years |
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If yes please
provide full details |
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How long have you been trading |
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If new please provide previous experience |
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Health and safety convictions: |
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If yes please
provide full details |
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Current Health & Safety Statement |
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Are you VAT registered |
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Please describe in detail work undertaken |
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Do you supply any goods |
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If yes please describe goods supplied |
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Do you import goods |
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If yes give full particulars including countries concerned |
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Estimated gross turnover |
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Number |
Wages/payments |
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Clerical and managerial employees who do not engage in manual labour |
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€
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Woodworking machinist
{whole or part-time} |
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€
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All other employees |
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€
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Labour only
sub contractor payments |
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€
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Bona-fide sub contractor payments |
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€
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If a limited company do you require working directors covered under employers liability cover |
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Are any flame cutting or welding plant or
other heat producing plant or process used |
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A height limit of 15 metres will apply, do you require a higher limit. If yes please state |
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metres |
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Are you an NSAI registered firm |
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Currently registered with SEI |
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If not registered with SEI please provide details: |
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Public liability limit of indemnity €6,500,000 any one claim
Products liability limit of indemnity €6,500,000 aggregate
Employers liability limit of indemnity €13,000,000 any one claim
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Optional covers please select if you require a quotation and we will contact you to discuss your
requirements: |
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Professional Indemnity |
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Tools of trade |
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Premises |
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Stock |
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Money |
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Goods in transit |
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Contractors all risks |
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Commercial vehicle |
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Personal Accident |
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Income protection |
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Directors and officers |
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Quotation is subject to our terms of business which you confirm you have read. Your proposal form is subject to acceptance by the underwriters and receipt of premium prior to cover been agreed. |
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TERMS OF BUSINESS
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click here to read |
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I have read terms of business |
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