Quotation Request Form

Fields marked with an * are required

Address of equipment (if different to above)

  • About you
  • Your equipment
  • Insurance History

Tell us about you..... (if your enquiry is for a club, please contact us for further information)

Address where your radio equipment is kept

Is your radio shack

Is your radio shack inside your home or in an external building (eg shed)

Tell us about your insurance history...

Have you had any claims or losses, whether insured or not, within the last 5 years?

Are you currently insured?

If yes, please provide the insurer name and renewal date

General questions

Has any insurer or Underwriter declined to issue or renew a policy or imposed special terms?

If yes, please provide full details

Have you ever been convicted of (or charged with but not yet tried for) any offence other than a driving offence?

If yes, please provide full details

Have you ever been declared bankrupt or the subject of proceedings or made any arrangement with creditors either in a personal capacity or in connection with any company, business, or firm with which you have been involved?

If yes, please provide full details