Request for General Liability Quote:

To request a quote for Professional Indemnity insurance, please complete the form below then press the "Get a Quote" button at the bottom.

For further information on our products and services you can email us at Info@policychoice.co.uk.

Personal Details

Your Email address:
Your Name:
Your Address and Postcode:
Your Telephone Number:
Your Preferred Contact Method:

Company Details
Your Company Trading Name:
Your Trade:
Your Company Type:
Annual Wageroll - Clerical employees:
Annual Wageroll - All other employees:
Estimated annual turnover:
How many full years have you been trading?

Cover required
Policy start date required:	(DD, Month, YYYY)
Please indicate the limit of indemnity required:
Please indicate the excess you would prefer:

Please supply details of any claims or incidents that may lead to a claim in the last 5 years (including date and nature of incident and any amounts paid or outstanding):


If you have any other comments relevant to your request, please enter them in the box below:

If you would like us to send you details of other products and services which might be of interest to you, please check this box:
Declaration
By submitting this form: I/We agree that if this insurance is completed, the protections and/or safeguards mentioned herein shall not be withdrawn or varied to the detriment of Underwriters without their consent.; To the best of my/our knowledge and belief, all the information provided in the Proposal Form is true and I/We have not withheld any material facts. I/We understand that non-disclosure or misrepresentation of a material fact will entitle Insurers to void the insurance.(N.B. A material fact is one likely to influence acceptance or assessment of this proposal by Insurers. If you are in any doubt as to what constitutes a material fact, you should consult your Insurance Broker).; I/We understand that the signing of this Proposal Form does not bind me to complete the Insurance but agree that, should a Contract of Insurance be concluded, this Proposal and the statements made therein form the basis of the Contract
Please enter your name below to confirm that you have read and understood the declaration
Forenames:
Surname:

Thank you for taking the time to fill out our quote request.

Personal Details

Company Details