Miscellaneous

For a Miscellaneous Liability Insurance indication quote, please complete the form below.



Insured / Business Name *
Address of business *
Broker Name *
Contact person *
Email address *
Full business description of all activities *
(when completing this section please “paint” a full picture of the risk)
Website: *
Number of years experience in this industry * Yrs
Estimated Annual Turnover for the next 12 months * $
Have you had any claims or incidents that may result in a claim? Yes      No
Do you manufacture, supply, distribute or sell products? Yes      No
If yes, please provide full details of products and estimated turnover from product sales for the next 12 months.
Any Imports or exports Yes      No
Please advise full details

1) Public Liability quote:
Limit required $10,000,000       $20,000,000
 
With the above information we can provide you with an indication quote subject to satisfactory completed proposal.