Prospective Entitlement

Get a quote

Please fill out the following questionnaire to receive a quotation for a personal Prospective Entitlement insurance plan. We will process your information and get in contact with you as quickly as possible.

Details of person to be insured

Full name

Message

How may we get in contact with you?

by emailby phone

Email address

Phone number

In order to provide you with a quote we would need the following information

Your age group

Details of jointly insured relatives

Should relatives be jointly insured?

noyes

Age group of relative	Favoured deductible amount

I have read the privacy statement and I do agree that my data will be analysed and saved electronically in order to provide the requested quote. Remark: You can withdraw from the agreement for the future at any time by sending an email to This email address is being protected from spambots. You need JavaScript enabled to view it..