To ensure validity of the policy you must answer the following questions truthfully, to the best of your knowledge and belief. You must disclose any facts which are material to the risk being proposed. Such material facts would assist the underwriter to assess the risk and determine whether or not to offer cover. If you are in any doubt about disclosing information you should contact us.

Please be aware your answers form the basis of any subsequent policy and the policy schedule is actually produced from your answers, please therefore enter answers as carefully as possible, doing your best to avoid typing errors. Thank you.

Your Details

Please use one line for each person and separate their name and date of birth with a comma. Date of birth should be in the format DD/MM/YYYY.
i.e. Mrs. Anne Example, 13/01/1975
Please select your title. If your title is not available, please select "Other" and fill in the resulting text box.
Unless agreed to the contrary, UK law will apply.
Contact Details
This is an ON-LINE live product only. Do you consent to use email for all matters relating to this policy.