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quote
Please complete this form to enable us to obtain a business quote for you.
If you don't feel like completing the whole form just give us your phone number and we will contact you.
( * required fields )
Name
(required)
Company
Phone
(required)
Email
(required)
Address
Nature of your business
(e.g. plumber)
How many years are you in business?
Please describe work that you do
What would your estimated annual turnover be?
Have you got any employees?
yes
no
If yes, please submit their details in the box below
Number of employees and annual wages in total
Clerical & Administrative
Directors (involved in manual duties)
All other Employees
Apprentices
Details of claims, losses
Have you had any claims within last 5 years?
yes
no
If yes, please submit the details in the boxes below
Date/ Brief Details/ How much was paid out?
Event 1
Event 1
Event 2
Other details
This form is for quotation purposes only and is not confirmation of a quote or insurance cover. Insurance cover will only commence on receipt of a completed proposal form, payment and written confirmation from Rooney Insurances.
Rooney Insurances Ltd is authorised by the Financial Regulator as a Multi-Agency Intermediary.
Rooney Insurances Limited
- c/o Martin & Garvan Insurances, 96 Upr. Drumcondra Road, Dublin 9
Phone: +353 (01) 837 9276
Fax: +353 (01) 833 3515
Email:
info@rooneyinsurances.ie
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