Elite

Health Insurance with all those important extras

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Type of Cover - for teams with less than 6 members, please complete an Individual quote per member

Individual Team

Select Sports Activity

Player Coach

Chosen Sport

Primary Sport (Match officials should select "Referee")

Title

First Name

Surname

Telephone

Postcode

Email Address

Date of Birth, E.g. dd-mm-yyyy

When would you like cover to start?

Have you had an existing policy elsewhere?

Yes No

Include Spouse/Partner?

Yes No

(Introducer) Spouse/Partner date of birth E.g. dd-mm-yyyy

How many additional family members or children would you like to include in your quote?

What is your Employment Class?

Parent/Guardian Confirmation

I confirm that I have entered the name, date of birth and primary sport of the person to be insured. For under 16 year olds, only Sports Accident Key and Sports Accident are available (Sports Accident death benefit is limited to £2,500 and Temporary Total Disablement benefit is excluded).

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