Include Foreign Use

Include Foreign Use (EU Member States Only)

 
1. Your Details:
Relationship Direct Customer Broker
Policy Number
Name
Registration Number
Contact Phone Numbers
Home
 
Work
Mobile
Email Address
2. Effective Date of Cover :
When do you require cover to start?
Date
 
Time
  
     
When do you require cover to cease? Date
  Time  
Note:Please note that cover cannot be backdated. In the event that you require immediate confirmation of cover, please contact the Motor Team on (01) 6363524.
List of persons who will drive (These persons must already be included in the schedules of drivers)
List of countries that you intend to visit
Comment
Please note the following

1) There may be an adjustment in premium for this alteration. In the event that you require immediate confirmation of cover, please contact the Motor Team on (01) 6363524 during normal office hours 9am to 5pm, Monday to Friday excluding Bank Holidays.

2) Direct and Brokers without a Delegated Authority Agreement
Please note submission of this form does not automatically change the cover under this policy until expressly confirmed by the company.

3) Brokers with Delegated Authority Agreement
Please Refer to your Delegated Authority Agreement
a) If this alteration falls within parameters of your Delegated Authority, cover is effective as requested.
b) If the alteration falls outside these parameters of your Delegated Authority submission of this form does not automatically change the cover under this policy until expressly confirmed by the company.