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John Smith Insurance Group: Business Questionnaire For Quotation

 

Your business is your Lifeblood; you simply cannot afford to be in business without adequate insurance. We all hope we never have a fire, burglary or any kind of claim, but nearly all businesses have a claim of some type sooner or later. At John Smith Insurance, we aim to provide you with insurance coverage ensuring minimal interruption during times of business trauma.

Simply fill in this form and we will provide a competitive quotation.

* Required fields
Name *
E-mail Address *
Business Name *
Address *
Telephone *
Best time to call
Check box if you have an existing policy
Existing policy expires (date)
Fire; building sum insured
Fire; contents sum insured
Loss of profits sum insured
Burglary sum insured
Public liability sum insured
Glass?
Machinery Breakdowns (units) 1-5
6-10
11-20
21+
Other insurance
Previous claims
Current Insurance Company
Premuim last year ($)
Any other questions that you have

I have read and agree to the Privacy Policy *

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John Smith Insurance Group

ABN 29 099 626 758 and ACN 099 626 758 
Australian Financial Services Licence Number: 246 802
Suites 41c & 41 g, 190-200 Jells Road,
Wheelers Hill, Melbourne, Victoria

(03) 9561 5577
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