Brokers Marine Trades Quote Request

Please complete this form if you would like to obtain a quote for Marine Trades Public and Products Liability. This form is not a proposal form and is not binding in any way.

Brokerage*

Contact name*

Email*

Phone*

Insured name*

Insured business address*

Street Address City State Postcode

Business or Occupation*

Date insurance required*

The Business

Gross income from business in the last 12 months

Estimated gross income for the next 12 months

Are subcontractors engaged?

YES
NO

Amount of gross income paid to subcontractors

Number of qualified tradesmen employed in the business

What percentage of income is derived from non-marine work?