Pre-contractual duty of disclosure

  You must answer all questions contained in this application form honestly and with reasonable care. Failure to do so may result in your policy being cancelled or we may refuse to deal with any claims or reduce the amount of a claim payment, as detailed under the Impact of Misrepresentation section, which you should read carefully.

The answers you provide are the basis upon which an insurance cover quotation will be offered or refused.
If any of the answers or information in this Completed Application Form is incorrect or inaccurate you must notify us immediately and obtain a revised quotation and complete a new Application Form.

This is an important document for you to read carefully and to retain in a safe place.

Warning
If you are not in a position to answer all of the questions asked of you in this cover application process, honestly and with reasonable care, then you should not proceed with your insurance quotation request.

1. Your Details

*We may call you in relation to your quotation
Maximum age is 75 years

2. Partner's Details

Maximum age is 75 years

3. Information



 If you'd like to talk to us about this quote please call us now on 01 859 9710.