PERSONAL ACCIDENT INSURANCE FOR FOOTBALL TEAMS

Personal Accident

Football Season 2003- 2004

ENQUIRY FORM AND APPLICATION FORM

Date cover to commence      

email:  

Address for Correspondence:

Name of assured Club:          

Number of Teams:                  

Number of Units:     MAX 4               

Claims Experience   i.e.  Dates:   Name of Member:  Injury sustained:   Period of Incapacity:  Total Cost of Claim

     

Please note: Incomplete application forms cannot be processed.

Thank you