Specialist Kart Insurance for the professional and enthusiast
  
 
  
Personal Injury Cover

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Your Details - New User
Title:
Forename: Surname:
Address Line 1:
Address Line 2:
Town:
County:
Postcode:
How did you find us:
Date of Birth [dd/mm/yy]:
Occupation:
Telephone:
Fax: Mobile:
Email:

Note: Check email address. If incorrect our formal quotation will not reach you since this is only sent by email		 Password:

Your Racing Licence
Type of licence held: How many years have you been competing?

Your Competition Activities
Championship / Series:
Approximately how many events will you be contesting this year?

Level of Cover required - (all cover is in respect of accident and excludes illness)
Benefits Important Notes Sums Insured
Death: This is following an accident and excludes illness.
Total Disability: This is for the very serious accident and one which would prevent you from attending ANY business or occupation. IF you have a highly specialised occupation where perhaps a relatively minor but permanent disability could cause the termination of this occupation, then we would recommend a policy more specific to such needs. Please call us for details.

Total Disability is a “lump sum” benefit. If the insurers have however made payments for loss of weekly income under this policy, the final sum paid will include a deduction of payments made.

There is a “waiting period” of 12 months unless medical examinations are able to conclusively concur that you are beyond any recovery within this 12 month period. This benefit does not include loss of eyes or limbs and we would recommend effecting PARTIAL DISABILITY cover below.
Partial Disability: Where you have lost an eye or eyes and / or a limb or limbs, this benefit will automatically pay you a proportion of the TOTAL DISABILITY sum insured specified above. Click here to view the full scale of compensation.
Loss of Weekly Income: Providing you are in gainful employment, should you be unable to work (and therefore receive an income) this insurance will provide necessary compensation. The weekly sum insured should be based on the nearest figure to your net weekly income. The insurers will pay this benefit up to a full 52 weeks, excluding the first 14 days. per week

Policy Extensions
Emergency Medical / Repatriation Expenses: This is NOT a private medical insurance. If you have an accident in the UK that requires emergency treatment the good old NHS will take care of you. You will only need this cover if you are racing outside of the UK and within Europe. If you are racing beyond European boundaries and you require this cover you will need to call us since there may be an additional premium to pay. Repatriation expenses are limited to £5,000 any one accident.
State how many events outside UK:
Do you wish to include cover whilst travelling to and from an event venue?

Other Information
Details of any previous injury. If none , state "none".
NOTE - your policy excludes pre-existing conditions
What date do you require cover to commence from? - This does not commit you to purchasing this insurance

Declaration
Material Facts and Non Disclosure
I/we hereby declare that to the best of my/our knowledge, that the statements made in this proposal are true and complete and that I/we have not suppressed or mis-stated any material facts. (Further Details)

Policy Wording
It is important that you read the policy wording before you effect cover with ourselves. (Policy Wording)

Application
I/we agree that this application and declaration, together with any information supplied by me/us, shall form the basis of the contract between myself/ourselves and the Insurer.
I/we understand that completion of this application form does not bind myself/ourselves or the Insurer to any form of insurance contract.

Privacy and Security

Important: I/we confirm that I/we have read and understood the above. Further I/we confirm we have checked the accuracy of all information supplied above.


    Premium inc. Insurance Premium Tax £0.00



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