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JUKES INSURANCE BROKERS
63 Broad St., Bromsgrove, Worcestershire, UK, B61 8LL
Tel: 01527 874 092 / 575 175
Fax: 01527 575 307
privacy policy
Quotation Request :
Retail, Business and Commercial Insurance


GENERAL DETAILS
Business Name: 
Business Address:  
Postcode:
 
Type of Business
Telephone:
e-mail address
Contact person
Estimated turnover  £ per annum
PROPERTY
(Indicate replacement cost)
Buildings    £ standard
accidental damage
Business contents / equipment
  £    standard
accidental damage
General Stock  £     Brief Description:
All Risks Items  £       Brief description:
Goods-In-Transit  £ Brief description:
Business Interruption  £ sum insured for 3 months   6 months    12 months
Money  £
   
LIABILITY
 
Public Liability £2 million £5 million £10 million Other (please state) :
     
Professional Indemnity Is cover required for professional negligence?  No     Yes
Employers Liabilty

Please indicate approximate total gross wageroll

Administration
Management
Manual  

Other      

 
Overseas work? no              yes   
   
CLAIMS
Please provide brief details of any claims giving year, type and amount of claim
OTHER
Name of Current Insurer:
Quotation for 12 months based on cover starting: (day/month/year)