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Personal Accident Insurance – Assessment of Demands and Needs
Policy Holder Details
Are you an existing MIB Customer?
*
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Please specify your Customer Number
Name
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First
Last
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First Name
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Last Name
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ID Number
Date of Birth
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Email Address
*
Enter Email
Confirm Email
Contact Phone Number
*
Cover Information
Annual Salary
In case of Salary based benefits
Cover
Occupational cover only
24Hour cover
Occupation
Hazards
Detail of any hazardous pursuits (e.g. work at heights) or sports
Additional Details
Additional Comments
Attach any relevant documents.
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Select files
Max. file size: 5 MB.
Terms Accept
*
I have read and accept MIB's
Client Terms of Business & Privacy Policy
.
*
I understand that by completing this form the data will be processed by MIB in line with GDPR and hereby consent that this data (including if needed sensitive data as defined in article 9 of GDPR) are used for the purposes 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 direct or indirectly involved in the insurance proposal/arrangements and whose data will be processed by MIB and the providers of insurance and ancillary services.
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Insurance
Health Insurance
Home Insurance
Travel Insurance
Motor Insurance
Boat Insurance
Personal Accident Insurance
Life Insurance
Small Business Insurance
Get a Quote
Make a Claim
How to Make a Claim
Insurance
Transit Insurance
Liability Insurance
Marine Insurance
Aviation Insurance
Property Insurance
Financial Risks Insurance
Professional Indemnity Insurance
Cyber Insurance and iGaming Exposures
Engineering Insurance
Employee Benefits
Construction Insurance
Motor Fleets & Tool of Trade
Risk Consultancy
Get a Quote
Make a Claim
How to Make a Claim