Contact Information

Policy Type*

Please note that we are currently not taking requests to insure drones. Thank you.

First Name*

Last Name*

Company

Occupation*

Occupation Description*

ID Number*

Date of Birth

Email Address*

Enter Email Confirm Email

Contact Phone Number*

Additional Comments

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.

Contact Information

Support

About MIB

Tell us what you think