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Insurance
Health Insurance
Home Insurance
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Personal Accident Insurance
Life Insurance
Retirement Planning
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Insurance
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Life Insurance Quote Form
Policy Holder Details
First Name
*
Last Name
*
Company
ID Number
Date of Birth
Date Format: DD slash MM slash YYYY
Email Address
*
Enter Email
Confirm Email
Contact Phone Number
*
Smoker/Non-Smoker
Smoker
Non-Smoker
Additional Policy Holders
Name
ID Number
Date of Birth
Smoker/Non-Smoker
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Additional Policy Holders.
Add Policy Holder
Maximum number of additional policy holders reached.
Cover Information
Bank Required
*
Is the policy required for a Bank Loan?
Yes
No
Amount of Loan
*
Term of Loan repayment/number of years
Bank Providing Loan
Additional Details
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.
Insurance
Health Insurance
Home Insurance
Travel Insurance
Motor Insurance
Boat Insurance
Personal Accident Insurance
Life Insurance
Retirement Planning
Sports Medical Insurance
Get a Quote
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
Name
*
ID Number
*
Date of Birth
*
Date Format: MM slash DD slash YYYY
Smoker/Non-Smoker
*
Smoker
Non-Smoker
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