Name of Organisation:

Contact name:

Contact email address:

Please retype the Contact email address here, to reduce the risk of errors:

Contact phone number:

Benefits

Cover provided in units of cover up to a maximum of five.

Cover applies to accidents arising whilst engaged in activities of the insured - i.e. it is not 24-hour cover.

The Temporary benefits apply per week up to 104 weeks. No excess period applies. These benefits will be restricted to £25 and £15 per week in total, respectively for volunteers who are not in gainful employment.

Accidents arising from some hazardous activities are excluded.

1. Basis of Cover - Insured persons to be aged between 16 and 75 years

2. Are all persons proposed for cover in good health and have no physical or mental defect or infirmity?

3. Has any previous Insurer declined a proposal, refused to renew a policy or imposed special terms and conditions?

If 'Yes', give details:

This Summary of Cover is designed as a guide only to the cover provided. Full details can be obtained from Keegan and Pennykid (Insurance Brokers) Ltd.

Please check the wording of this Proposal and the data you have entered carefully before proceeding by clicking on the 'continue to next stage: final check' button, below. Clicking on the button will not submit your details yet, but will cause another page to load.

The new page that loads will give you a chance to check your data again, and if you need it you will get another opportunity to make changes before finally sending the data.

If you notice an error shortly after sending the data (when you see the page that invites you to print the submitted data out for your records) you can resubmit a corrected version. After submitting, you can try using your browser's Back button to return to the form. If you are lucky, the data might still be displayed, which would save you typing it all in again.

If you resubmit in this way, please also indicate this here:

If you only notice an error later and it's too late to go back and resubmit, or you find that the data has disappeared from the form when you return to it, please make a copy of your printed record and fax it to us along with an indication of the change(s) you wish to make.

Alternatively, please call us on (0131) 225 6005 and explain the change(s) you would like us to make for you.

Please note that in such circumstances we may have to send you a form to fill in on paper and sign in order to confirm changes.