SR Insurances - Travel and Holiday Insurance

Picture of the Taj Mahal

Picture of a skier Picture of people paddling in the sea Holiday & Travel Insurance

Carefree cover for you and your family.

Whether you are travelling by air, sea, coach rail or car,
we can meet your holiday or travel insurance needs all in
one package.

Just fill in this short form and we will provide a quote for you as soon as possible.

Insured Persons

INSURED PERSON(S) State MR/MRS/MISS/MS	Click each box as appropriate
	Age (Years)			Family Unit (See Note 1)	Delete Money, Luggage and Valuables	Winter Sports
	Under 2	2-18	70 & Over	Family Unit (See Note 1)	Delete Money, Luggage and Valuables	Winter Sports

Note 1: A Family Unit comprises 2 Adults & 2 Children under 18. All ages at date of departure

Do you want to exclude Luggage, Money & Valuables (discount available)?

Your details
Title

Forenames

Surname

Address
Postcode
Telephone Number
E-mail

Travel details

Period of Travel - maximum of three months

From
To (date of return to UK)
TOTAL NUMBER OF DAYS

Select the area of the world you are travelling to:

Additional Information
Does any one in the party have any Pre-Existing Medical Conditions?
If 'Yes', please give details

Will any of your party be taking part in any Hazardous Pursuits e.g. Paragliding, Jetskiing?
If 'Yes', please give details

Will any of your party be taking part in any Winter Sports?
If 'Yes', please give details

Do you want cover to include business equipment?

If you make regular holiday trips it may be worth considering Multi-trip Annual Policy cover. This is an annually renewable policy, attracting No Claims Discount in subsequent years. The maximum duration of any one trip is 31 days.

If you would like us to provide you with a quote for a Multi-trip policy just check the adjacent box

And finally…
Is there anything else you need to tell us about?

How did you hear about this web site

The personal details you have submitted on this form will be used only for the purposes of supplying you with a quotation. None of this information will be made available to other companies or organisations for the purpose of mailing, promotions, direct selling or any other offers.

Thank you for filling in this form. Please ensure you have filled in as much as possible - the more details you give us the better quote we can give you!

For you own records you may like to have a printed copy of this form. Just press the Print Form button.
Press the SEND button to forward your details to us.

We will forward a quote as soon as possible.

Travel Insurance

Sharpley & Regent Insurance Services Ltd.
38 Alexandra Road, LOWESTOFT, NR32 1PW
Tel: 0845 130 0202 (Calls charged at local rate)
Fax: 01502 532605

ã Sharpley & Regent Insurance Services Ltd. 1999 - 2007