Thank you for your interest in our Directors & Officers insurance scheme, to enable cover to be issued please complete your details below:
Company Name:
Contact Name - Title & Surname:
Contact Name - First Name:
Business Address:
Contact Number:
E-mail Address:
Acceptance Criteria:
(If you do not comply with all or any of the criteria below please call Insurance2day on 01384 423 888 for details of other products which may be more suited to your requirements)
Can you confirm that you comply with all of the acceptance criteria detailed below:
Please provide full details if you do not comply with the Acceptance Criteria
Directors & Officers Limit of Indemnity:
Confirmation of Annual Premium (£)
Method of Payment
If Other, please give details
N.B. No cover is in place until payment is received and you receive written confirmation of cover.
Please press the submit button to request cover