Comprehensive General Liability (CGL) Insurance Quotation

1

Company Details

Registered Company Name * Please enter company name.

Business Registration No. (SSM) * Please enter SSM registration number.

Nature of Business / Principal Activity * Please specify principal business activity.

Contact Person Name * Please enter contact person name.

Phone Number (WhatsApp) * Please enter a valid phone number.

Corporate Email Address * Please enter a valid email address.

2

Contract Details

Contractor Category * Please select contractor category.

Estimated Contracts in Next 12 Mths * Please specify estimated number of contracts.

Detailed Scope of Work * Please describe scope of work.

Total Annual Contract Value (RM) * Please enter total contract value.

Largest Single Contract Value (RM) * Please enter largest single contract value.

3

Work Location & Risk Exposure

Primary Work Locations / Sites * Please enter primary work locations.

Work Environment * Please select work environment.

Refinery / Petrochemical Works? * Please select an option.

Specify Petrochemical / Refinery Details * Please provide refinery work details.

Fire or Explosion Risk Exposure? * Please select fire/explosion exposure.

Specify Hot Work & Safety Controls * Please detail hot work controls.

4

Financial & Experience Profile

Annual Company Turnover (RM) * Please enter annual turnover.

Total Annual Payroll (RM) * Please enter total annual payroll.

Years in Business * Please specify years in business.

Total Number of Employees * Please specify employee count.

5

Insurance & Claims History

Any Liability Claims in Past 5 Years? * Please select claims history.

Details of Past Claims * Please detail past claims.

Total Incurred Claim Amount (RM) * Please enter claim amount.

Do you have an Existing CGL Policy? * Please select option.

Current Insurer & Expiring Limit * Please enter existing insurer details.

6

Coverage Required & Uploads

Required Limit of Indemnity (RM) * Please select required indemnity limit.

Preferred Deductible / Excess * Please select deductible preference.

Proposed Policy Start Date * Please select policy start date.

Proposed Policy End Date * Please select valid end date.

Contract / Scope of Work Document (Optional)

Click or drag contract file here

Accepted: .pdf, .doc, .docx, .png, .jpg (Max 10MB)

Filename.pdf

I hereby declare that all information provided above is true, accurate, and complete to the best of my knowledge for underwriting evaluation.

You must agree to the declaration before submitting.

Comprehensive General Liability (CGL) Quotation

Ahmad Fedaeez