Group Personal Accident Insurance Quote

/Group Personal Accident Insurance Quote

Please complete the following form in full to receive a quotation.

Business Name (required)

Address (required)

Email Address (required)

Contact Name (required)

Contact Phone

If the business is a Limited Co please indicate the number of Directors

Number of Directors

Business Occupation (required)

Is window cleaning work undertaken?
 Yes No

If yes

Is this undertaken using water fed pole systems?
 Yes No

Is ladder work undertaken above 3 storeys in height?
 Yes No

Do you use ropes/platforms
 Yes No

Please detail any hazardous leisure activities:

Please provide your annual wageroll

Are you human?