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Equiry Form

At Independent Insurance Services we offer an Extensive and Exclusive range of Insurance products for Commercial & Personal Clients.

As an experienced brokerage we'll take pain out of finding a product that not only meets your specific requirements but saves you money.

For potential savings please complete the form including your reference number:
Ref. Number:

Contact Information
title: surname: first name:
phone no: email:
company position:
Perferred Contact Time
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Company Information
company trading name:
address:
town/city:
post code:
brief business description:
renewal date: dd/mm/yyyy
cover required:
I have fully read and understood Independent Insurance Services Terms & Conditions.

INDEPENDENT INSURANCE SERVICES

THE INDEPENDENT GROUP

Independent Insurances Services is a Trading Style of IMIA Limited, which is Authorised & Regulated by the Financial Conduct Authority.
Independent Insurance Serivces is registered in Northern Ireland under registered No. NI054893.
Reg Office IMIA Limited, Independent House, 11 Hamilton Road, Bangor BT20 4JP