AUTHORISED & REGULATED BY THE FINANCIAL SERVICES AUTHORITY
* denotes required field
NAME OF CONTACT *
POSITION
EMAIL ADDRESS *
COMPANY NAME *
COMPANY REGISTRATION NUMBER
TELEPHONE NUMBER *
WHAT GOODS OR SERVICES DO YOU SELL? *
DO YOU HAVE ANY EXISTING CREDIT INSURANCE POLICIES?
Yes
No
THE NAME OF THE INSURER *
RENEWAL DATE *
TYPE OF INDICATION REQUIRED *
Please Select
UK
Export
Combined
Single Risk
ANTICIPATED
INSURABLE TURNOVER
IN THE NEXT 12 MONTHS (£) *
HOW MANY CUSTOMERS DO YOU ALLOW A CREDIT LIMIT OF MORE THAN £500? *
MAXIMUM AMOUNT ANY CLIENT IS LIKELY TO OWE YOU AT ANY ONE TIME (£) *
HAVE YOU SUFFERED ANY BAD DEBTS IN THE LAST 3 YEARS?
Yes
No
PLEASE COMPLETE THE FOLLOWING:
TOTAL
INSURABLE TURNOVER
FOR THE PAST 3 YEARS? (£) *
TOTAL BAD DEBTS FOR THE PAST 3 YEARS? (£) *
VALUE OF LARGEST BAD DEBT IN THIS PERIOD? (£) *
Tel. 0845 5390053
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