Broker Enquiry Form

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Broker Scheme Enquiry Form

Telephone Include Int'l Code

Dealer Sold Used Equipment

Dealer Sold OEM New Equipment

E/W on Used Equipment

E/W on New Equipment

Check If Start Up Proposition

Summary About Opportunity

Upload Information About Opportunity

Check If Insurance Capacity Sought As Insurer

Check If Insurance Capacity Sought As Reinsurer

Check If Existing Opportunity Has Data Available

Likely Expectations Of GWP 0 - 12 months

Likely Expectations of GWP 0 - 24 months

Likely Expectations of GWP 0 - 36 months

Broker or Introducer Name

Email *

Risk Territory (State Worldwide if Applicable)

InImportant Notice

The completion of the above form does not bind you to any contract.

We trust the completion of the above form has been undertaken to the best of your knowledge.

The information in the above form is useful insofar as enabling us to formulate an indicative quotation.

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