Liability Insurance Quotation Form

Please complete as much of this form as possible as it will allow us to provide you with the most competitive quotation. Fields marked with an * are required.

Contact Details

Contact Name*

Company Name*

Company Status*

Number of Years Trading*

House / Building Number or Name*

Street Address*

Postal Town*


Post Code*

Telephone Number*

E-Maill Address*

Best method to contact you

Contact me by

Telephone E-Mail

If by Telephone please select

Best Days

Monday Tuesday Wednesday Thursday Friday Saturday

Best Time

Any Time 9am - Noon Noon - 3:00pm 3:00pm - 6-00pm

Business Infomation

Description of the Business / Trade*

Number of Years Experience*

Any process involving heat

Yes No

Height Limit

5M 10M 15M Over 15M

Depth Limit

1M 2M 3M 4M 5M Below 5M

Cover Required

Public Liability*

Employers Liability*

Number of Manual Principals*

Number of Manual Staff*

Number of Clerical Staff*

Annual Wageroll Manual £*

Annual Wageroll Clerical £*

Estimated Total Annual Turnover £

Current Insurance Details

Any claims in the last 5 years

Yes No

If Yes state approximate Dates, Causes and Costs

Renewal or Start Date*

Current Insurer*

What is your Renewal / Expiring premium?*

Please confirm you have read the Fair Processing Notice before submitting this quotation request*

Please enter the phrase as it is shown in the box above.   

Henderson Insurance (NE) Limited Fair Processing Notice

In your dealings with us you may provide information that includes data that is known as personal data.
The personal data we collect will include data relating to your name, address, date of birth, wider contact details and data relating to health or criminal offences.

We will process your personal data to allow us to provide you with our services as your insurance broker in quoting for, arranging and administering your insurances and in arranging insurance premium finance, where applicable.

It will also be used to manage future communications between ourselves and communicate about our products and services. You can opt out from receiving such communications services by emailing

We will only use your data for the purpose for which it was collected. We will only grant access to or share your data within our firm, with authorised partners, and our market service providers such as insurers and premium finance providers where we are required or entitled to do so by law under lawful data processing.

If you require further information on how we process your data and our lawful basis for doing so, please contact our data privacy representative by emailing or view our Privacy Notice at