Engineering Insurance - Quotation Request

Proposer's name

E-mail address

Company or trading name

Business address

Postcode

Telephone No

Fax No (optional)

Contact name
(if different form Proposer)

Inspection Section

Please insert the quantities of each of the following you wish to insure

Description

Quantity

Air Vessel

Heating Boiler

Small Steam Boiler
(cafe type)

Standard Steam Boiler

Steam vessel

Steam Piping

Air Conditioning (25kw max)

Compressor/Motor

Gas Oil Burner

Passenger/Goods Lift

Vehicle Lifting Table

Small Garage/Factory Crane

Jack

Gantry/Runway

Powered Fork Lift Truck

Pallet Truck

Misc. Tackle (Slings/Shackles)

Insurance Section

Sudden and Unforseen Damage
(please insert sum insured required)

Claims Section

Has any accident/breakdown occured in the last five years?

  Yes

  No

if yes please give details below, if no please click here

Cause

£ Amount

Date

Renewal Date of present insurance (if applicable)

Insurance required from

Preferred Payment Method

choose >>> Credit Card Debit Card Cheque Direct Debit