Travel Quote Request / Enquiry Form draft...
 You have a duty to provide complete and accurate information. Failure to disclose material information may invalidate cover and could mean part, or all, of a claim may not be paid. If in doubt disclose it anyway.
NOTE: * identifies a mandatory question, which must be answered to allow your enquiry to proceed
Personal details:
Are you a permanent UK resident?
 
      Full name of Applicant
 * 
Email  
Address
* 



Post Code
* 
Day Time Phone Number
* 
Date of Birth *
If you or any of your travelling companions have a medical condition which has been suffered or for which medical advice, treatment or medication has been received prior to the date of issue of a policy you must declare this when taking out your policy. Do you agree?
Names and Dates of Birth for ALL other travellers
  
 Type of Travel Policy Required:
Single Trip
   Date of Departure Date of Return
Annual Multi-Trip
 Maximum number of days for any one trip up to days

Travel Destination

   UK EU Worldwide
Any Hazardous Activities:
Sailing
Diving
  
Or Other - please specify
   

Terms of Business Agreement | Privacy Policy

created by BreezeMarine

Curtis Marine Insurance is the trading name of Curtis Marine Insurance Brokers Limited, which is Authorised and regulated by the Financial Services Authority. Registered in England & Wales.
Registered Number: 6465804. Registered Office: Plymouth Marine Centre, Pomphlett Quay, Billacombe Road, Plymouth, PL9 7HP.