Quotation Personal Accident Insurance |
Type |
: |
Personal Accident Insurance |
|
|
|
Policy Wording |
: |
As agreed by Underwriters |
|
|
|
Period of Insurance |
: |
|
Currency |
: |
|
Are you requesting this insurance as a |
: |
|
|
|
|
Insured Person |
: |
|
Date of birth |
: |
|
Beneficiario |
: |
|
Name Beneficiary |
: |
|
Qual è il rapporto con il beneficiario? |
: |
|
: |
|
Main / Usual Occupation |
: |
|
Additional Occupation |
: |
|
|
  |
|
Type of Competition License |
: |
|
|
|
E-mail |
: |
|
Social Security / Fiscal No. |
: |
|
Invoice address |
: |
|
Domiciled Address |
: |
|
Beneficiary Address |
: |
|
Participating in (Main championship) |
: |
, Race events, Test days. |
Additionally participating in |
: |
, races, testdays. |
As an instructor / driver coach |
: |
days per annum. |
|
Addition to cover |
Do you want to include cover for personal equipment? |
: |
|
|
Secondary cover for loss of helmets, race suits, fire proof clothing, race shoes, race gloves. Losses sustained whilst traveling or at the track. |
: |
|
|
Operative Time of Cover |
: |
|
Additional information |
: |
|
|
• Excluded are any other dangerous sports activities unless informed upfront. |
• Excluding any pre-existing medical circumstances. |
• Subject to receipt of satisfactory proposal form and justification of the sum insured. |
• Premium excluding insurance premium tax where applicable. |
• The quoted premium is purely an indication and pending formal approval and acceptance of insured perils and premium by Insurers. |
|
Remarks |
: |
|
Security |
: |
100% London Markets and/or A-rated security, to be confirmed upon inception |
|
We understand that it may not be easy to decide which insured options and sums insured you may require. We therefore offer you the option of a financial analysis and a tailormade quotation. For this you need to complete your client profile. Do you wish to complete your client profile? |
|
|