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Name & Surname*

Address of residence to be Insured*

Postal Address*


Mobile number*

I.D Card No.*

Email address*

Buildings Sum Insured*

Contents Sum Insured*

Unoccupancy Period not more than:*

All Risks Sum Insured:*

Cover Required on All Risks:

Maltese Islands*



Claims Past 5 Years*

Description of claims*

Date and time of quotation

I have read and accept the Terms and Conditions

I understand that by completing this form my data will be processed by MIB Group in line with GDPR. I confirm having reviewed MIB’s Privacy Policy  and hereby consent that this data (including if needed sensitive data as defined in article 9 of GDPR) are used for the purpose of providing your insurance services.


I also understand that it is my responsibility to secure and hold the necessary consent from any employees, beneficiaries or other third parties directly or indirectly involved in the insurance proposal/arrangements and whose data will be processed by MIB Group and the providers of insurance and ancillary services.