Contact Details
Date (dd/mm/yyyy):
Title:
Mr
Mrs
Miss
Ms
Other
Name:
Position:
Name of School:
Address:
City:
County:
Postcode:
Local Authority:
Email:
Telephone:
Facsimile:
Current Insurer Details
Current Insurer:
Renewal date:
Target Premium:
Current Premium:
Current daily benefit:
Current Excess:
Level of Stress Cover:
Which insurers are you looking at?
Staff Details
(full time equivalency basis)
Staff
Number of Staff
Daily Benefit Required £
Excess Days, (waiting period)
Teaching
Support
Other
Extra Benefits Required
Is Maternity Cover required:
Yes
No
Continuous or Annual Policy required?
Con
Ann
Please indicate any other benefits required:
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