Request a quote — workplace accident insurance

1 · Who is applying?

You are… *

Company Self-employed (with staff)

Company name *

Last name *

First name *

Manager or HR contact of the company.

Company number (BCE) *

2 · Your activity

Professional activity (detailed) *

The rate depends directly on the real activity: be concrete (tasks, sites, machines, travel…).

Operating address (if different from registered office)

Desired cover start date *

Urgency

Hiring within 48h?
Enable for priority handling.

3 · Insurance history

Have you been insured for this risk before? *

Yes No

Name of current / previous insurer

Any claims in the last 5 years? *

Yes No

Claims detail (date + amount paid by the insurer)

A claims statement may be requested by the insurer to validate the transfer of cover. You can attach it below.

Do you confirm that no contract has been cancelled by the insurer (e.g. for non-payment)? *

Yes, I confirm No

This information matters to the insurer; we can discuss it together if needed.

4 · Staff to insure

For each category, enter the number of people per working-time scheme, and the category's gross annual payroll. Totals are calculated automatically.

5 · Your documents (optional)

Claims statement(s), copy of the current contract, any document useful for pricing.

Drag your files here or click to browse

PDF, JPG, PNG, DOC/DOCX · 5 MB max/file · 15 MB and 5 files max in total

6 · Your contact details

Phone *

Email *

Any comments (optional)

Fast reply — often within 24 business hours. You receive an acknowledgement by email straight away.

Request received!

Thank you, your quote request is in our hands. You'll receive a confirmation email right away.

We launch the comparison and get back to you as soon as possible with our market study.

Request your workplace accident insurance quote

Your quote request

Request received!

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