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ABC Insurance quote

ABC Insurance

 

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About you

Firm Name/Trading Name*

Business (i.e. Solicitors)*

Your reference*

Number of offices*

Main contact name in full*

Email Address*

Daytime Telephone Number*

Evening Telephone Number*

Mobile Telephone Number*

Company registration number (if applicable)*

About the deceased

Name of Proposer in Full*

Name of Deceased*

Date of Birth of Deceased*

Date of Death of Deceased*

Total value of Estate for Distribution*

Relationship of Proposer to Deceased*

Address details of Deceased*

Name(s) of Personal Representatives*

Level of cover required

Please identify the total value of the estate for distribution, the answer to this question will determine the premium paid

Select the Value of estate

Premium paid
 Less than £100,000

£159.00
 Less than £250,000

£212.00
 Less than £500,000

£318.00

Further items required

Date of probate or letters of administration granted

I confirm, that all surviving children and/or spouses have been provide for
I confirm 

Details of financial provisions made to unknown third parties

A copy of the Deceased's Will, if made