PHA LAPTOP COMPUTER INSURANCE
Regulated by the Financial Services Authority

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Policy Wording

Laptop Computer Insurance
If you prefer to apply off-line, just print out and complete this form then send to this location:-

Burnett & Associates plc
39-41 Victoria Road
Woolston
Southampton
SO19 9DY

Or FAX to:- 02380 435 354

A PDF version of the form is available by Clicking Here.
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Print, complete and send this form to confirm your eligibility and quotation.
You will be contacted with confirmation of your premium so that cover may be arranged.
More details of terms & conditions may be found on the Laptop Insurance page.

NAME (+ COMPANY NAME IF APPLICABLE)

ADDRESS

TOWN/CITY

COUNTY

COUNTRY


(UK ONLY)

POST CODE

TELEPHONE NO.

EMAIL

EQUIPMENT DETAILS + SERIAL NUMBERS + SUM INSURED PER ITEM

TOTAL SUM INSURED

DO YOU REQUIRE COVER FOR INCREASED COST OF WORKING AND DATA REINSTATEMENT?

EXCESS REQUIRED

CHECK THE BOX FOR
THE CORRECT PREMIUM
Sum Insured
Std Premium
with £100 x/s
with £250 x/s
£0 - £1,500
£75.00 £67.50 £63.75
£1,501 - £2,000
£100.00 £90.00 £85.00
£2,001 - £2,500
£125.00 £112.50 £106.25
£2,501 - £3,000
£150.00 £135.00 £127.50
£3,001 - £4,000
£200.00 £180.00 £170.00
Over £4,000
Please quote me for this
Digital Camera
£25.00

COMMENCEMENT DATE REQUIRED

CLAIMS DETAILS :-

ALL CLAIMS FOR THIS
TYPE OF EQUIPMENT DURING
THE LAST 3 YEARS.
IF NONE, STATE - 'NONE'.

COMMENTS

I confirm that I require insurance cover as per the above application and that all questions and statements made by me are true. The computer equipment, the subject of the insurance, is owned by me, or for which I am responsible under a rental, hire purchase or lease agreement.


Signed ................................................................



Dated ................................................................

PHA Travel.com

Sent this form to:

Burnett & Associates plc
39-41 Victoria Road
Woolston
Southampton
SO19 9DY

Or FAX to:- 02380 435 354

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PHATravel.com is a trading style of PHA Insurance Services Ltd - Registered Office: 1173 Bristol Road South, Northfield, Birmingham, B31 2SL, England, Companies House registration number 5092395 (England). PHA Insurance Services Ltd is directly authorised by the Financial Services Authority - ref. no. 418244.

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Arranged in association with PHA Insurance Services Ltd
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PHA Insurance Services Ltd is fully committed to the FSA's Treating Customers Fairly (TCF) initiative