group accident and sickness insurance

GROUP ACCIDENT & SICKNESS INSURANCE

Employers can make provisions in the event of death, loss of eyes or limbs due to an accident and a weekly income if temporarily incapacitated from work on a group basis for their employees.

If you require cover for yourself only please complete the Personal Accident & Sickness quotation request.

 

Please complete the quotation request below or click here if you would like a consultant to call you.

call us on 01726 61811

GET A GROUP ACCIDENT & SICKNESS INSURANCE QUOTE...

about you...

Proposer's Name

 

E-mail address (required)

 

Address

 

Postcode

 

Telephone No

 

Contact Name

 

about The insured

Name

 

Date of birth

 

Height

 

Weight

 

Occupation

 

Please insert full details of manual duties (if any)

 

medical information

a) Heart trouble

Yes No

b) High blood pressure

Yes No

c) Circulatory problems

Yes No

d) Tuberculosis, chest or lung problems

Yes No

e) Back disorders/problems

Yes No

f) Complaints of the digestive system

Yes No

g) Nervous/anxiety problems

Yes No

h) Diabetes

Yes No

i) Any other sickness or recurring complaint

Yes No

j) Has the insured person consulted any doctor or received any medical attention or advice in the last three years?

Yes No

If you have answered yes to any of the medical questions above please give full medical details here

 

other information

Has the Insured Person ever been declined or charged extra premium for any accident, sickness or life insurance in the past

Yes No

Does the insured person participate in any hazardous pursuit, activity or sport, or reside or travel extensively outside the UK

Yes No

If you have answered yes to either of the above questions please give full details below

SCHEDULE OF COMPENSATION

Please insert the sums to be insured for the following:-
(please note that benefits 8 & 9 must not exceed 75% of gross income (including all other insurance benefits and payments  received from an employer), if benefits are payable to an individual.

1. Death due to accident

 

2. Loss of limb by one accident

 

3. Total and irrecoverable loss of sight of one eye by accident

 

4. Loss of two limbs by accident

 

5. Total and irrecoverable loss of sight of both eyes by accident

 

6. Loss of one limb and total irrecoverable loss of sight of one eye by accident

 

7. Permanent total disablement by accident

 

8. Total disablement by accident (per week)

 

deferment period (min 2 weeks)

 weeks

benefit period (max 104 weeks)

 weeks

9. Total disablement by accident and illness (per week)

 

deferment period (min 2 weeks)

 weeks

benefit period (max 104 weeks)

 weeks

10. Permanent total disablement by accident and illness

 

Renewal Date of present insurance (if applicable)

 

Current Insurer

Insurance required from

 

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