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Business Insurance Quote

Thank you for considering our on-line commercial / business insurance quote service.

Please fill in the following form as fully as possible, then click 'submit' at the end of the form.
You can use the TAB key to move to the next field. We will respond with your quote as soon as we have researched the market for the best available deals that fit your requirements.
(* required fields)

Business Name: *
Address of the Business
   
Business details:  
Trade / business type:
Number of staff:
Annual salary / wages paid: $
Sales / Turnover / Gross Rentals per annum: $
Building occupied by (please select from list):
Period occupied by proposer: Years
Period in this type of business: Years
   
Fire insurance details:  
Age of building: Years Stories sqm
Condition of building (please describe):
Fire Protection:
Single sprinklers Hydrant/Hoses
Dual sprinklers Extinguishers
Vats (deep frying): Yes No
Thermostatically Controlled Yes No
   

Details about the premises' construction:
Walls:
Brick Iron Fibro
Concrete Timber Other
Roof:
Iron Tiles Other
Floors:
Concrete Timber Other
   
Burglary insurance details:

Details about anti-theft protection you currently have:
Alarm:
Monitored Local No alarm
Connection:
Landline   Securitel Dialler
Sensors:
Infra Red    Window detector / tapes
Deadlocks:
All doors   Other
Other:
Patrols    24 hour security guard
Windows:
Bars    Grills Shutters Keyed Locks
Roller Doors
Central Locking Device Internal Deadlocks
   
   
Please detail briefly any insurance claims in the last five years:
   
Have you ever had any insurance cancelled or declined or special terms imposed?: Yes No
Have you ever been charged or convicted of any criminal offence or declared bankrupt?: Yes No
   
Insurance Amounts:  
Building: $
Stock: $
Other contents: $
Removal of debris: $
Loss of rent: $
Rewriting of records: $
Fire $
   
Business interruption  
Insurable gross profit: $
Additional increased cost of working $
Claims preparation costs: $
   
Burglary  
Stock: $
Tobacco / Cigarettes: $
All other contents: $
Specified items: $
   
Money  
In transit: $
Business Hours $
Outside Business Hours $
Locked safe: $
Residence: $
Safes / storerooms: $
   
Glass  
External:
Internal:
Signs: $
   
Liability  
Public: $
Products: $
Goods in Legal Control $
   
General property  
General property: $
Description of property to be covered
   
Computers  
Equipment: $
Machinery Breakdown $
Increased costs $
   
Machinery  
Unspecified: $
Specified items: $
Do any boilers or pressure vessels require certification?: Yes No
   
Food spoilage: $
   
Any other comments, requests or relevant information you need to add:
   
Contacting you about your quote:
In order to select the most appropriate cover for you, it may be important to discuss the details of the quotes in person. Please make sure you leave a contact phone number and best time to call to facilitate this.
   
Your name:
Company name:
Phone number (please include area code): *
Mobile phone number:
Fax number:
Best time(s) to call:

Please send my quote by

 Email Phone Fax
Your email address: *
Postcode: *
Partner ID:
   
 
 
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