Commercial
Legal Expenses - Quotation Request
Proposer's name
E-mail address
Telephone No
Postal Address
Postcode
Trade or Business
General
Questions
Description of work undertaken
Date of commencement of business activities
How much do you pay annually in wages before deductions?
How many people do you employ?
Have you ever held cover for this business or any
of the covers applied for before?
Has any insurer ever declined a proposal, refused
renewal , terminated an insurance or imposed special terms
if 'yes' please provide details
Has your business, you, or any of your partners
or employees been involved in any legal dispute, action, prosecution,
Customs and Excise dispute, Inland Revenue investigation/enquiry
or DSS review during the last 5 years (excluding driving offences)?
if 'yes' please provide details including date, outcome
and the amount of legal costs and accountants' fees incurred (including
employment awards)
To the best of your knowledge and belief are there
any redundancies envisaged in your business within the next 12
months?
if 'yes' please provide full details including the
number of redundancies envisaged
In the last 3 years have you been taken over, merged
with or taken over any other company, or to the best of your knowledge
and belief is it likely that your company will atke over another
firm within the next 12 months
if 'yes' please provide full details in respect of
the company(s) with whom you have (or intend to) merged with or
taken over
Cover required from
to
Renewal date of present insurance (if applicable)
Preferred Payment Method
choose >>>
Credit Card
Debit Card
Cheque
Direct Debit
