Lawley Insurance Brokers, Slough, UK

Funeral

Name of organisation:
Address
Proposer:
Date:		Email:
Position in organisation:

No. of persons in organisation aged between 16-65 yr:
How long has the organisation been in existence? (yr.)
Sum Insured required?
Cover will become operative for a period of 12 months

Claims record over the past 5 years (previously insured or not)

once Underwriters have accepted this Application form. IN THE EVENT OF A CLAIM, Proof of Membership must be provided at the time of death along with a UK Death Certificate and proof of Date of Birth. Claims are only payable in the UK.
To make an application please print off this form and send it, completed, to the address above or fax to 01753 534100.

325 High Street, Slough, Berkshire, SL1 1TX

Tel: 01753 537100
Fax: 01753 534100
Email us here

A New Insurance for religious and Welfare Associations to provide cover for burial Expenses on any registered member who dies within the United Kingdom. Cover is available on a yearly basis at a cost of only.

(Select on Sum Insured per Association only)

ADULTS 16 TO 65 YEARS OF AGE

RATES ON APPLICATION

Our Premiums are available subject to all registered members being insured and who are permanent Residents of the United Kingdom and cover is subject to a satisfactory Claims Record. If this is of interest to you please write, phone, fax or E-mail us today at the address and numbers below with completed details.