Confirm an offer

We would like to thank you for choosing Pantaenius. For to sign the insurance you can either call us, e-mail us, send us the form which you have received together with the quote or simply fill in the following online form.

Please refer to the offer document which you have received from us for the quote number and the amount to be completed in the form field "deductible". If you wish to have another deductible then indicated, please contact our office.

Please be informed that it is not possible to backdate the start date.

All fields are mandatory fields.

Confirmation of cover will be sent to you on the next working day if you use this form outside our office hours, during weekends or bank holidays.

YOUR DETAILS

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