Free Insurance Quotation From Direct Electronic

The following cover is provided:

• Budget Cover to avoid NHS waiting lists
• In-Patient cover without limits
• Private Ambulance cover
• Direct Billing in prefered hospitals
• ú100 per night when opting for NHS treatment
• Home nursing cover
• Maternity & Children's benefit
• Alternative Medicine cover
• Consultation and Day Care Patient cover (optionally without limits)
• Unlimited overall UK cover

Proposer Details

   
Renewal Date of Existing Insurance: 
          Immediate Cover Required: Yes  No
     
     e-mail address: 
         First name: 
          Last name:  Title:
Residential Address: 
                     
        Town/Suburb: 
       County/State: 
            Country: 
      Post Code/Zip: 
  Home Phone Number: 
  Work Phone Number: 
         Fax Number: 

As policies can insure yourself and/or your family, please answer the relevant questions.

Married       Single

If single, please give your age: 

If insuring a couple, please give ages of:

           Husband: 
     and      Wife: 

Number of children: 
    and their ages:            


Number of people, therefore, to be insured 


OPTIONAL
Please tick if you would like quotations for:

 WorldWide Cover (ú1 Million Annual Limit)
 Travel Insurance with Comprehensive Cover

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