Public & Products Liability
Business Name
*
Business Address
*
Description of business activities
Number of years in business
Contact Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
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Limit of Indemnity
*
Please Select
$5,000,000
$10,000,000
$20,000,000
Other
Annual turnover
Number of Employees
*
Do you use contractors?
Please Select
Yes
No
What do contractors do for you?
Do contractors have their own Public & Products Liability Insurance?
Please Select
Yes
No
Annual payments to contractors
Have you sustained any Public & Products Liability claims in the past 5 years?
Please Select
Yes
No
Are there any other facts that an insurer should be aware of?
Please Select
Yes
No
If yes to either of the above two questions, please advise details
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