Business Insurance Quotation Form

Business Insurance Quotation Form

Please provide the details below to receive a customised insurance quotation for your business. Within our office hours, we endeavour to contact you within 1 hour of your requested call back time. Capital Indemnity Ltd are Authorised and Regulated by the Financial Conduct Authority.
Business Name ( including any trading names).*
Contact Person Full Name

First NameLast Name
Contact Email Address*
example@example.com
Contact Phone Number
Address*

Street Address

Street Address Line 2

City

Post Code
What is your main Trade?*
Business Description
What type of insurance do you require?

Employers LiabilityPublic/Products LiabilityGroup Personal AccidentProfessional IndemnityProperty Insurance
Number of Employees
What is your estimated total wage-roll for all of your employees over the next 12 months? ?
Business turnover ? *
How many years has the business been trading continuously claim free and had continuous liability insurance in place?
How many years experience do you have of this trade or business?
Do you hold qualifications for the work you are undertaking?
Please confirm if the proposer or any principal, partner, director, or shadow director is involved in the business.
A) Have been declared bankrupt or insolvent, or are currently subject to any bankruptcy or insolvency proceedings?
B) Have ever been convicted of, charged with, cautioned or have a prosecution pending for any criminal offence, other than motoring offences or those considered spent by the Rehabilitation of Offenders Act?
Do you wish to provide any other information or have any specific requirements?
Policy Start/Renewal Date

MonthDayYear
Date
Best Call Back Time

Hour Minutes

AM/PM Option
You can contact us by phone or email – whatever works for you. Phone: 0203 488 7193 Email: info@capitalindemnity.co.uk
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