insurance2day


Insurance2day Insurance Services Ltd are authorised and regulated by the Financial Services Authority and are members of:





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    COMPANY DETAILS
    Company Name:
    Contact Name - Title & Surname:
    Contact Name - First Name:
    Business Address:
    Postcode:
    Contact Number:
    E-mail Address:
    Business Description:
    Number of Years Trading:
    Renewal Date (if applicable):
    Target Premium (£):
    COVER REQUIRED
    Insured Persons:
    If All Directors & Employees, please give names of those requiring holiday trip extension:
    If Specified Travelers, please give details:
    Name
    Age
    Holiday Extension
    Winter Sports
       
    (please check box)
    (please check box)
    1.  
    Yes
    Yes
    2.  
    Yes
    Yes
    3.  
    Yes
    Yes
    4.  
    Yes
    Yes
    ANTICIPATED TRAVEL PATTERN
    Destination
    No of Trips
    Average
    No. of Days
    Maximum
    No. of Days
       
    1.   U.K. / U.K.
    2.   E.U.
    3.   USA / Canada
    4.   Rest of World
    Details of Any Manual Work:
    Additional Information:
    ADDITIONAL INFORMATION
    Please provide details of ALL and ANY losses you have suffered or claims you have made in the last five years (please advise date(s), cost(s) and circumstances:
    Any additional information/comments or material facts that may affect an insurers willingness to offer cover:
    Standard exclusions: 1) Hazardous Sports & Pastimes & 2) Pre and Existing medical injuries
    Thank you for completing your details - please press the submit button for a quotation.