When we send you our quotation, we will disclose our full
commission to you and we will rebate half of this back to
you as a reduction in premium.
| |
Please
fill out the form to obtain a quotation. |
ABOUT
YOU AND YOUR BUSINESS |
|
Name:
|
|
Your
business name: |
|
1st
line address: |
|
2nd
line address: |
|
3rd
line address: |
|
Postcode:
|
|
E-mail:
|
|
Your
website address: |
|
Daytime
telephone : |
|
Best
time to phone : |
(Monday to Friday) |
Please
describe your profession : |
|
When
was the business established? |
|
How
many years experience do you have? |
|
What
was your turnover in the past year? If this is your
first year of trading, please advise what expect it
to be £ |
|
Which
level of professional indemnity cover do you require? |
|
ABOUT
YOUR ACTIVITIES |
Please ensure the following
adds up to 100% |
Do
you undertake any work with third parties where the
total contract price exceeds £1 million? |
|
Hardware
sale, installation & maintenance / 3rd party software
sale, installation & support: |
% |
Website
design & hosting / ISP resale / Domain name registration:
|
% |
Website
design ONLY: |
% |
Own
software sale, installation & consultation: |
% |
Software
development & consultation: |
% |
Outsourcing
services: |
% |
IT
advice & management consultancy: |
% |
IT
project management / interim management: |
% |
IT
training: |
% |
IT
contract programming: |
% |
Specialist
IT security consultancy: |
% |
Telecommunications
consultancy: |
% |
IT
cabling: |
% |
Other
activities (please describe with %): |
All boxes added
together should total 100% |
Do
you work in any other country outside of the UK, the
Channel Islands or the Isle of Man? |
|
Do
you sub-contract work out to other parties? |
|
Do
you carry out any government or local authority work?
|
|
Have
any claims of a professional or product liability
nature, been made against your business during the
past 3 years involving any partners, pricipals or
directors?
If yes, please give details of
when, what happened and how much was paid out
|
.
|
Where
is your principal business located? |
|
|
|
ABOUT
YOU AND YOUR STAFF |
including
all Directors, Partners and Principals |
How
many people work in a manual capacity more
than 10% of the time? |
|
Of
these people, how many work away from your
premises, more than 10% of the time? |
|
How
many people work in a non-manual capacity,
more than 10% of the time? |
|
Of
your non-manual people, how many work away
from the office more than 10% of the time? |
|
How
many people are involved in your business? |
|
|
|
ABOUT YOUR CONTRACTS |
Do you undertake work providing
services to any of the following sectors? If you answer
YES, please give further information in the comments
box at the end. |
Railway:
|
|
Medical:
|
|
Pharmaceutical:
|
|
Aviation:
|
|
Nuclear:
|
|
Oil
& Petrochemical: |
|
Do
you provide any work relating to trading and settlement
systems for the financial sector? |
|
Do
you carry out any cabling other than connecting standard
hardware within business or home premises? |
|
Do
you undertake any work on Process Control Software/Hardware,
Enterprise Resource Planning Software or Gaming Software?
|
|
Do
you undertake any work away from your premises involving
heat producing equipment other than soldering equipment?
|
|
Do
you act as an application service provider? |
|
|
|
Do
you enter upon any contracts involving the erection,
maintenance and operation of telecommunications transmission
equipment and infrastucture? |
|
Are
you an internet service provider, providing internet
connectivity to your clients, other than as a reseller
of such services? |
|
Comments:
If you answer "YES" to any of the "Contracts"
questions above, please give further information here.
Additionally,please also enter anything else you think
you should declare. |
|
OPTIONAL EXTRA
COVER |
|
Do
you wish to include Public Liability cover? |
|
Do
you wish to include Employers' Liability cover? |
|
Is
legal expenses insurance required (starting from just
£90)? |
|
Is
cover for business equipment required? |
|
When
you have finished, please click the submit button
and receive a 50% rebate of
our commission from the premium.
|
|
|
