SME Registration

Part 1 Personal Details








Choose your start date

Only fill in the questions below if your business is not currently insured with us.

Is there any insurance on the same property in force with this or any other Insurance Company?
yesno
If yes, state the names of the Insurance Companies

Claim details (if any) for the past 5 years

Has any insurer(s) at any time declined your proposal/ imposed special terms/ cancelled or refused and existing insurance? If yes, please give full particulars


DECLARATION
I do hereby declare that the above answers are true and that I have withheld no material information regarding this Proposal. I agree that the information provided to you on this application shall form the basis of the insurance contract between me and Quantum insurance. Our liability does not commence until the acceptance of this proposal has been formally acknowledged by Quantum insurance the corresponding premium has been paid, except as agreed otherwise by Us in writing.

Part 1 Personal Details








Choose your start date



PART 2 - GROUP PERSONAL ACCIDENT

Only fill in the questions below if your business is not currently insured with us.

yesno
If yes, state the names of the Insurance Companies

Claim details (if any) for the past 5 years

Has any insurer(s) at any time declined your proposal/ imposed special terms/ cancelled or refused and existing insurance? If yes, please give full particulars


DECLARATION
I do hereby declare that the above answers are true and that I have withheld no material information regarding this Proposal. I agree that the information provided to you on this application shall form the basis of the insurance contract between me and Quantum insurance. Our liability does not commence until the acceptance of this proposal has been formally acknowledged by Quantum insurance the corresponding premium has been paid, except as agreed otherwise by Us in writing.

Part 1 Personal Details








Choose your start date



PART 2 - GROUP PERSONAL ACCIDENT





PART 3 - ELECTRONIC EQUIPMENTS INSURANCE




Only fill in the questions below if your business is not currently insured with us.
Is there any insurance on the same property in force with this or any other Insurance Company?
yesno
If yes, state the names of the Insurance Companies

Claim details (if any) for the past 5 years

Has any insurer(s) at any time declined your proposal/ imposed special terms/ cancelled or refused and existing insurance? If yes, please give full particulars


DECLARATION
I do hereby declare that the above answers are true and that I have withheld no material information regarding this Proposal. I agree that the information provided to you on this application shall form the basis of the insurance contract between me and Quantum insurance. Our liability does not commence until the acceptance of this proposal has been formally acknowledged by Quantum insurance the corresponding premium has been paid, except as agreed otherwise by Us in writing.