Insurance Quotation

Please complete this short Statement of Facts to receive your individual insurance quotation.


Statement of Facts

In deciding whether to accept the insurance and in setting the terms and premium, we will have relied on the information you have given us. You must:

  • give a fair presentation of the risk to be insured.  A fair presentation is one which clearly discloses all material facts and circumstances (whether or not subject to a specific question) which you, your senior management and those responsible for arranging this insurance, know or ought to know following a reasonable search;
  • take care by ensuring that all information provided is correct, accurate and complete.


A material fact or circumstance is one which is likely to influence the insurer’s acceptance or assessment of this proposal. If you are in any doubt as to what constitutes a material fact or circumstance please speak with us.

  • 1. Your Contact DetailsEdit
  • 2. Your companyEdit
    • E.g.

    • Please enter numbers only.

    • Please enter numbers only.

    • Please enter numbers only.

    • Please enter numbers only.

  • 3. Business activitiesEdit
  • 4. Statement of FactsEdit
    • By completing this Statement of Facts you confirm these facts whether provided by you or anyone else on your behalf provided are accurate.

      You must read this document to ensure that all the facts stated below are accurate and complete. If any of the facts stated below or any of the information provided to us is not correct or needs to be changed, you must tell us before the start of the period of insurance.

      If there are changes to this information during the period of insurance you must tell us. When we are notified of a change we will tell you if this affects your policy. If you do not inform us about a change it may affect any claim you make or could result in your insurance being invalid.

      Please agree or disagree with the following points (note, when we say "you", we refer to the proposed insured company"):

  • 5. Cover RequirementsEdit
    • Please advise the limit of indemnity for which you require a quotation by ticking the relevant boxes. If you would like us to provide options e.g. £1m and £2m, then please choose £specify and put the options you require in the freetype box.

  • 6. Claims ExperienceEdit
    • Can you please provide further information in respect of each claim, investigation or loss:

      1) Date

      2) Brief description of the nature of the claim, investigation or loss

      3) Values of any payments made or current estimate of loss

      4) Measures taken to prevent a reoccurence

    • Help

      .zip or .pdf extensions only. Max allowed size is 10MB.

  • 7. DeclarationEdit
    • Material information

      Please provide us with any information which may be relevant to our consideration of your proposal for insurance. If you have doubt over whether something is relevant, please let us have details . 

      Your information

      Here at Protean Risk we take your privacy seriously and will only use your personal information to provide your insurance quotation and for our legitimate business interests.  Click here to learn more about these interests and when we may process your information in this way.

      We will never share, rent or pass your information to any third parties other than insurance companies quoting for and providing your insurance and only then when you have specifically instructed us to seek insurance terms or obtain insurance cover on your behalf.

      Next steps

      We will provide a quotation based on your responses, but we will require some additional information in order to put the insurance in place and this could include:

      1. Business plan
      2. Biographies of directors, partners, professional and trading employees
      3. Latest report and accounts, if applicable
      4. Fund performance report, if applicable
      5. Further specific questions related to your Business Activities.

      The exact requirements will be outlined along with our quotation.

    • Please enter your initials.