Annual multi trip insurance



Please take a moment to fill out this form and one of our brokers will contact you shortly to offer you a quotation or discuss your requirements further.
Title* 
First name* 
Second/middle name
Surname* 
Date of birth* 
Place of birth* 
Sex* 
What is your occupation* 
Are you self employed* 
What is your employers business
Name or number of your home* 
Postcode* 
Do you own or rent this property* 
E-mail address* 
Daytime contact number (including code)* 
Evening contact number (including code)
Mobile contact number (including code)
How did you hear about us* 
When do you need this insurance to start* 
(cover should be taken as soon as you have booked a trip)
Where in the world might you be travelling?* 
All policies will have an excess, do you want to pay to remove this?* 
Do you need winter sports cover?* 
Do you want cancellation cover?* 
Do you want cover for personal belongings?* 
Do you want cover for business equipment?* 
Who do you need to be covered?* 
What is the age of the oldest person travelling?* 
What is the age of the youngest person travelling?* 
Do you or anyone travelling have any existing medical conditions?* 
Privacy and Data ProtectionThe Rossborough Group holds your details in accordance with relevant Data Protection Law in the UK, Isle of Man and Channel Islands. Some or all of the information you supply to us in connection with your insurance proposal will be held on computer and may be passed to insurance companies for underwriting and claims purposes. In addition, we may use some of the information to advise you of other products and services offered by the Rossborough Group. If you do not wish to receive such details please contact our Compliance Officer.
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