Personal Accident Quote Request

Please enter the full details of your personal accident quote request and one of our team will be in contact.

Alternatively, please call +44 (0)1799 524202 to discuss your requirements.

A

Policy Holder

B

Period

If one day, just select "from" date

C

Details

D

Requested Sums Insured

Suggested to be at least mortgage / loan amount.
Up to a max of 5X annual salary.
* per week
Up to a max of 75% of the gross weekly wage.
Only relevant if competing overseas. Please advise how many events will be overseas and in which countries.
E

Medical Questions

Have you been prescribed medication, or received treatment or attended a medical practitioner’s surgery in the last 2 years?
If yes, please provide details?
Have you attended a hospital or clinic as an out-patient or in-patient in the last two years?
If yes, please provide details?
Been currently put on a waiting list for treatment or investigation?
If yes, please provide details?
Been diagnosed by a medical practitioner as suffering from a terminal illness?
If yes, please provide details?
F

Additional Information