Personal Details

    Name and Surname*

    Telephone*

    NIE Number*

    Occupation

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    Post Code*

    Email*

    Date of Birth*


    Insurance Details

    Equipment description

    Where do you keep clubs and accesories?

    Has a claim been made with the goods to be insured in the last 3 years?

    Details of claim

    Do you have a physical impairment that may afect the personal accident cover?

    Details of impairment

    Equipment value*

    Golf club Membership


    Current Insurer

    Insurance Provider

    Current Policy Number

    Date of Renewal

    Additional comments


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