Seico Insurance Consultants

Liability Combined Insurance

Thank you for using the liability combined insurance quotation form. After submitting this form, you will be contacted by us with the most competitive for your policy within the next 24 hours. Different companies have different terms and conditions so it is important to check the quotes you recieve.

About You Client Name:
Trading name (if applicable):
Postal Address:
Post Code:
Risk Address (if different):
Risk Post Code:
Contact Name and Number:
E-mail Address:
Business Description (exact work being undertaken) if applicable:
Number of years in Business:
Is Employers Liability required (standard limit of £10,000,000)	yes no
Is Public/Products Liability Cover Required	yes no
What Level of Cover is Required, £1 million, £2 million or £5 million
Annual Company Turnover
Wageroll
Principals, Partners and Directors Wageroll
Manual Wageroll
Clerical Wageroll
Bona Fide Sub Contractors Wageroll
Number of Manual Employees
Number of Clerical Employees
Number of Bona Fide Sub Contractors
If you answer yes to any of the following questions, please provide the additional details in the continuation box at the end of the form.
Does work involve heat away from premises	yes no
Does work involve handling Asbestos, Silica or similar	yes no
Does work involve handling Chemicals, acids, gases, explosives or dangerous substances	yes no
Is work carried out abroad	yes no
Have you or your partners or directors ever been convicted or prosecuted for any criminal offence involving dishonesty, arson, theft, wilful damage or have any prosecutions outstanding	yes no
Have you or your partners or directors ever been refused insurance of this type	yes no
Please give details of any claims during the last 5 years whether insured or not
continuation area for additional comments in response to 'no' answers:

Preferred Method of Payment:	Cheque Credit Card Direct Debt