Directors and Officers Quotation

Your Details

Title: *
First name: *
Surname:*
Email address: *
Contact number: *
Mobile number (if different):
Address:*
Postcode: *
Company Details
Company name:*
Company registration number:*
Company type/description:*
Gross turnover: *
Insurance Details

Have any claims been made against the proposer in the last 6 years, whether successful or not, in respect of the risks to which this proposal relates?
Yes  No

If yes, please provide further details on all previous claims:
Date Details of claim
Claim 1
Claim 2
Claim 3

Do the reports and accounts for the last two financial years show a positive net worth, a net profit (after tax, interest etc)?
Yes  No

Which limit of liability is required?


If another amount is required, please state:

Your Enquiry
Date cover required / renewal date:
Details of your enquiry:
Please note; cover is not in force until confirmed by us.
Contacting You
Preferred contact method:
Preferred contact time (Monday-Friday):
How did you hear about us:*
Towergate Risk Solutions is a trading name of Towergate Underwriting Group Ltd.  We would like to contact you from time to time about products and services (or with news, offers, services and promotions) that we feel may be of interest to you. By providing us with your contact details, you consent to being contacted by these methods for these purposes.

Please tick the box if you prefer not to receive marketing communications from us by post or telephone.  
Please tick the box if you prefer not to receive marketing communications from us by email, text messaging or other electronic means.