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





GROUP PERSONAL ACCIDENT INSURANCE QUOTE

Insurance2day Insurance Services Ltd acts an independent insurance intermediary authorised and regulated by the Financial Services Authority and is a member of the British Insurance Brokers Association (BIBA) and the Commercial Broking Alliance (COBRA).

For a group personal accident insurance quotation from our panel of insurers please complete your details in the form below.

Same day quotes and instant cover available - for assistance please call
01384 423 888, Monday to Friday between 9.00 am - 5.00 pm
   
COMPANY DETAILS
   
Company Name:
Contact Name (inc Title):  
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 Named, please give details:
Period of Cover:
Territorial Limits:
   
Clerical/Managerial Wage Roll:   No. of Employees: 
Manual Wage Roll:   No. of Employees: 
Details of Work Away From Premises:
Additional Information:
Details of Work Outside of U.K.:
 
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 & Existing medical injuries
 
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