Your Details:
Full Name:
Address Line 1:
Address Line 2:
Post Code:
Telephone Number:
Email Address:
Single Trip:
Amount of Days:
(For trips of 186-366 days long stay cover applies)
Start Date:
(Please count travelling days to and from within days) (dd/mm/yyyy)
Multi-Trip:
Start Date:
(dd/mm/yyyy)
Maximum Trip Duration:
31 Days
45 Days
60 Days
Persons to be Insured:
Applicant Title and Full Name
Date of Birth
Business Option
1.
Yes
No
2.
Yes
No
3.
Yes
No
4.
Yes
No
5.
Yes
No
6.
Yes
No
Geographical Limits:
European Union
Worldwide
FOR VARIATIONS IN THE STANDARD POLICY PLEASE RING A MACCLESFIED ADVISOR TODAY ON WHO WILL DISCUSS YOUR REQUIREMENTS ON 01625 610 301
Macclesfield Insurance Services Ltd is authorised and regulated by the Financial Services Authority No.417382
