Your details
Insurance Cover
Payment

Acceptance Criteria
  • You the insured or any director, partner or principle are currently a resident of the Republic of Ireland.
  • I agree to maintain client’s records and retain them for at least 5 years. If I have not done this in the past or am just starting in business, I agree to do this now.
  • I have never had any claims made against me.
  • I have not been subject to nor have any pending disciplinary hearings against me.
  • I am not aware of any incidents that have occurred which may have given rise or may give rise in the future to a claim under the policy.
  • I have never had suits for negligence, error or omission made against me.
  • Under current or any previous trading titles, I have never been convicted of any criminal offence, other than motoring, or have any prosecution pending.
  • I have never had any insurer cancel, decline, refuse to renew or only accept on special terms, my liability insurance.
  • I have read and agree to the Insurance Product Information Document. Click here to read the Insurance Product Information Document.
  • I have read and agree to the Terms of Business of BMIB. Click here to view our Terms of Business.
  • I have read and agree to the Data Protection of BMIB. Click here to view our Data Protection.
  • I hereby declare and warrant that all the statements and particulars in this application are in all respects complete and true, that they are material, and that I have not suppressed or misstated any material facts and I agree that this proposal form shall be the basis of the contract with the underwriters and deemed to be part of the insurance coverage issued to me.

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Please fill in the form below, then click "Next". The fields marked * must be completed, other fields may be left blank.

Title* e.g. Mr/Mrs/Ms
Your First name*
Your Last name*
Trading name (leave blank if none)
Limited company
Postal address line 1*
Postal address line 2*
Postal address line 3
County*
Eircode*
Country
Email address*
Telephone number
Mobile number*
Previous insurance*
Inception date Date when you would like insurance cover to start

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Please tick what you require cover for.

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Business Equipment Insurance - Cover up to €10,000 worth of your business equipment and trade contents for only €104.00.
Protect your equipment today with a simple, affordable addition to your policy.
Tick the below box if you wish to avail of the extra cover;

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Declarations

  • I am not a student but fully qualified.
  • I understand that I hold an appropriate qualification / relevant industry experience for the cover I have applied for.
  • Please note that in the event of a claim proof of qualification and/or any such relevant industry experience may be requested.