Corporate Private Medical Insurance Quotation

If you are currently uninsured, we can provide you with a competitive quote. However, if you are currently insured, we will endeavour to either improve your cover or reduce your premium, or both. When you submit the details below, we will send you an information pack, including a quotation, within 10 working days.

 

Company, Business or Corporate Quotation
Title
First Name:
Surname:
Name of Company:
Building Number or Name:
Street:
Town or City:
Postcode:
Daytime Telephone: *
Evening Telephone (if appropriate):
Fax:
Email: *
Position:
Type of Industry:
Number of employees to be included:
Number of employees in the company:
Do you currently have PMI cover? yes no
If so, with which company?
What is the policy name ( i.e. Primcare / Premier Cover, etc. )?
What is the excess amount ( i.e. £100 )?
What is the name of the hospital list ( i.e. Countrywide / Scale C, etc. )?
When is the renewal date?
When are you likely to start your company policy?
How did you hear about us?
 
I have read and understood your terms of business. * yes