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Brennan Insurances Oil Facility Quick Quote Form

Please anter the required details and click submit to save.
All boxes marked * are required.
Name
Address
 
 
Contact Name
Email
Renewal Date
Current Insurer
Business Activities
Liability
1) Please enter the total number of premises used
2) Please advise the projected wage roll split into the following categories
NumberWageroll €
a) Clerical Staff
b) Loaders
c) Drivers
d) Any Other Staff
Please describe activities these staff are engaged in :
1) Please advise project turnover €
Property
1) Buildings
1) Contents
1) Loss of Revenue
Claims
Please provide full details of all claims in the last five years
Motor Details
Schedule of Vehicles
Please give details of all vehicles.
YearMakeCarrying CapacityValue




















Schedule of Drivers
1) Total Number of Drivers

Please give the following detals for any drivers who are under 25 or holders of provisional licences
Name Age Occupation Licence Claims / Accidents or Convictions

























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