Commercial insurance quotation request

Please complete this form in as much detail as possible. Someone will be in touch promptly following receipt.

Complete this simple form to get the best value Commercial Insurance - FAST
What insurance is required or what type of risk would you like cover for. (We'll discuss the details with you later).
Business name:
What town or city are you in or close to?
What is your postcode?
What type of entity is the business?
Years of trading
Contact Name
Contact Position
Contact Phone Number inc STD
Contact email address
Please describe the nature of your business and the activities you undertake
How many different premises locations do you have
Your Approximate turnover in Thousands	£ ,000
How many Employees - include directors
If renewal premium received enter it (nearest £)	£
Enter Last year's premium (nearest£)	£
Renewal Date	DD MM YY
Current Insurance position
Current Insurer
How many brokers are/will you seek quotes from?
Current Insurance Broker Name
Please provide details of any claims in the last 5 years and any other information you think we should know
Important. If you are an associate / fellow of the IIB or have been asked to complete this form by an IIB person please put your/their name and IIB email address here:	Name
	Email
	In the first instance, who should we contact : Business Contact IIB Contact
Press the submit button once only to send this form. There may be a short delay before you see the acknowledgement.	Submit
	To Clear Form and start again


©Copyright SigBizInfo Limited Registered in England - No 4229417