Please use the form to request a proposal form for accident/ sickness unemployment insurance.


Your name
Address
Address
Town
Postcode
e-mail address
Occupation
Period Of Service
Why you want this policy
Date of Birth	(must be between 18 and 60 for our accident, sickness unemployment insurance policy)
Level of Benefits required
Total Monthly Benefit	(including mortgage protection)
Mortgage Payments

Benefit Period (if a choice)
Other information/ requests
Declaration I have completed the form to the best of my knowledge and belief. I have made a full disclosure of all material facts. I have read and understood the Important information below. I understand that there is no cover in force until confirmed by B. Portwood & Co Ltd, a satisfactory proposal form completed and accepted and payment of the premium made - either in full or an instalment plan set up acceptable to B. Portwood & Co Ltd. Insurance UK at Portwood home page

Important

All information on this website has been provided in good faith. Although every effort has been made to ensure its correctness errors may have been made or policy information out of date.

If as an insurer you find errors or wish us to change information/ add/ remove policies please contact us on 0870 7456247.

All information on this website has indicative status only and no liability can be accepted for any use made of it. Any quotations you obtain must and will be confirmed by us before cover can be issued. As required by GISC we will advise you of main policy cover, terms and conditions if such information is not already on our site.

You are reminded of your obligation to inform underwriters of all material facts when obtaining a quotation before going on cover. A material fact is one which could affect the policy in any way. If you are in doubt whether a fact is material it should be disclosed as we accept no liability should a policy be voided or terms amended due to non disclosure.

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