PharmaTax

PharmaTax

1 General questions and details
2 Your insurance
3 Payment Information
  • Please note: Your cover will not start until we have accepted this application. We reserve the right to refuse acceptance of any application for insurance. No liability is undertaken by us in connection with this proposal until cover has been issued with our authority.

    By completing this application, you consent to accept the Insurance Policy Terms & Conditions. A copy of the Policy Document is available on request. You also agree that you have read the Keyfacts and leaflet about our insurance services.

    Fields marked with an asterisk (*) are required.

  • Please enter a value between 1 and 1.
  • Price: £ 98.55
  • £ 0.00
  • Important Notes
    Before you complete the following declaration, please make sure that you have answered all the questions relating to the cover and not deliberately ignored information. It is essential that you disclose accurately all facts which influence acceptance of this application or terms to be applied. If you are not sure whether to include certain information, please do so anyway. If you do not tell us something relevant, your insurance may not be valid.

    Declaration
    I have read this proposal form and checked the answers given. As far as I know, the information on this form is accurate, true and complete. This proposal and declaration will be the basis of the Policy.