Multi Home appliance Insurance application form

BIBA (British Insurance Brokers Association) web-site

Please use the form below for our home multi-appliance insurance policy - or telephone 0844 8262618 - this product is administered from our Gateshead Office

The standard price for 5 items is £10.08 per month ( or £7.06 for 3 items). The items below will cost £1.06 per month each extra. This is a non-advised sale. It is up to you to check that the policy cover meets your requirements - see the policy summary if not already done so.

Plasma tv and LCD televisions (maximum size: 63") (excludes pixellation/ screen image burn)
American-style Fridge Freezers
Range Style Cookers (No Aga's)
Combined washer/dryer
All products MUST be out of manufacturer's warranty i.e. at least 1 year old.
You can add products as they qualify - subject to maximum selected (3 or 5) with no administration fee (the monthly price only goes up if the new item added is one of the list above.

Your name

E-mail address

We may send you information from time to time about insurance generally and special offers. If you do NOT want to receive it check and we'll only send details about this enquiry/policy.

Address line 1

Address line 2

City

County

Country (must be UK)

Post code

Telephone No.

Policy Type

Inception Date

NB Cover starts 28 days after inception date.

Policy Wanted

Further Information needed

Type of Product - White Goods are at the bottom of the lists	Manufacturer	Model	Purchase Price (nearest £)	Date of Purchase

Please NOTE

In order for us to set up this policy we will require your bank and credit card details. As this is not a secure server we recommend you call us during office hours once the submission has been made. No cover is in force for 28 days after the policy is set up.

Note: Hit submit button once only

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