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Quotations

Name and Surname (*)

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Identity Number

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Full Address (Incl. Postal code)

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Do you require building cover? (*)

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Sum insured of building

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Any building claims?

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Security at home





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Do you require household contents cover?

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Sum Insured

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Any household claims?

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Year model of vehicle

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Make of vehicle

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Model of vehicle (e.g. 1.6 GLE)

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Sum insured of vehicle

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Registered owner of insured vehicle

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Is vehicle being used for business / private purposes?

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First licence issue date / year

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Regular driver of insured vehicle

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Vehicle security (e.g. alarm, immobiliser)

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Regular driver's ID Number (If not insured)

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Marital Status of insured

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Is vehicle financed or not?

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Parked behind locked gates / garage?

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Any previous insurance

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If yes, please supply name of company

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Any motor claims / losses

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How long were you insured without claiming?

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Contact number/s (*)

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E-mail (*)

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Please entre in security code (*)

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