ACCIDENT MANAGEMENT FORM
If a friend, family member, or referrer, please provide their name and contact number.
This information is used exclusively for our marketing purposes.
“All your personal information is protected under the Data Protection Act 1998 and registered with the ICO.”
Personal Info
Your Details
Contact Details:
Business/Trade Address:
Company Details
Premises
Cover Details
Stocks to be insured:
Claim Summary
Employer Reference Number Details
Policy Start Date
in accordance with our Terms and Conditions & Privacy Policy/h6>
By clicking submit, you give your explicit consent for us to use the data provided in accordance with the Data Protection Act 1998. This data will be used to offer the best possible quote and may be shared with both offline and online markets.
