Cover Required
Total Equipment Value Total Annual Premium
Nil policy excess
(inc. IPT @ 5% and policy fees)
Up to £1,500 £95.00
£1,501 – £2,000 £120.00
£2,001 – £2,500 £145.00
£2,501 – £3,000 £170.00
Over £3,000 Please call Insurance2day on 0800 055 60 83
Company Name:
Contact Name - Title & Surname:
Contact Name - First Name:
Contact Number:
E-mail Address:
Make & Model:
Serial Number:
Value (£):
Details of Any Other Cover Required:
Please Confirm Annual Premium (£):
Method of Payment
If Other, please give details
Inception Date:
N.B. No cover is in place until payment is received and you receive written confirmation of cover.
Have there been any claims, or circumstances that may give rise to claims, such as would be covered by the proposed insurance in the past five years and are there any other material facts that may affect an insurers willingness to offer cover (if you are unsure as to whether a fact is material please disclose) ?
Any additional information/comments:
Thank you for completing your details - please press the submit button to request cover