Our Privacy Statement, Terms and Conditions, Initial Disclosure Document and Terms of Business are those on which we intend to rely and for your own benefit and protection we urge you to read these carefully before proceeding. If you do not understand any point please ask for further information.
I agree to receiving marketing information from Bridge Insurance Brokers Ltd or from selected business partners
Name:
Trading name(if any):
1st line of address:
Postcode:
Contact Telephone:
Email Address:
Number of years trading
Type of business:
How many working Proprietors / Partners / Directors are there:
1 2 3 4 5 6 7 8 9 10 More than 10
Employers Liability Cover:
IF YES:
Number of Manual Employees 1 2 3 4 5 6 More
What limit of Public Liability is required:
Please select £1,000,000 £2,000,000 £5,000,000
Business Equipment Cover :
Please select Not Required £2,500 £5,000
Stock Cover (kept within the property):
Please select Not Required £1,000 £2,500 £5,000 £7,500 £10,000
Have there been any incidents in the last five years which have or could result in a claim?
Please select Yes No
If yes, please provide details:
Claim/Loss 1 Date:
Circumstances:
Value:
Claim/Loss 2 Date:
Who is your current insurer?
When is cover required?
(dd/mm/yyyy)
What are you currently paying?
Any further information:
IMPORTANT: In order for us to process your quotation we have made certain assumptions. By submitting, you confirm that you have read and agree with the statements click here to view NOTE: If information provided is incorrect or incomplete Insurers may not pay your claim. Details you provide may be checked by Insurers against data held elsewhere.
IMPORTANT: In order for us to process your quotation we have made certain assumptions. By submitting, you confirm that you have read and agree with the statements click here to view
NOTE: If information provided is incorrect or incomplete Insurers may not pay your claim. Details you provide may be checked by Insurers against data held elsewhere.
