Application form - Mutually Protected International

APPLICATION DETAILS

Company Name*

COMPANY INFORMATION

Company Number*

Country Of Incorporation*

ADDRESS INFORMATION

Registered Address*

Correspondence Address*

Principal Business Activity*

COMPANY DETAILS

Number Of Employees*

Number Of Directors*

Principal Contact Name*

Position*

Email Address*

Contact Number*

Annual Company Turnover*

Date Of Year End*

PLEASE ENTER THE NAMES OF THE POLICY PARTICIPANTS BELOW:

Participant 1 Name

Participant 2 Name

Participant 3 Name

Participant 4 Name

Participant 5 Name

Participant 6 Name

PLEASE SELECT YOUR RISK COVER OPTIONS BELOW:

Credit Risk

true

Amount (Credit Risk)

Key Person Protection

true

Amount (KPP)

Cyber Risk

true

Amount (Cyber Risk)

Media Liability Protection

true

Amount (MLP)

Business Interruption

true

Amount (Business Interruption)

Fraud Risk

true

Amount (Fraud Risk)

Supplier Failure

true

Amount (Supplier Failure)

Terrorist Activities

true

Amount (Terrorist Activities)

DECLARATION AND SIGNATURES

I Hereby Confirm That The Information Provided In This Application Form Is Accurate, True And Correct.*

First Name*

Last Name*

Date*

**Please Complete Supplementary Application Forms Based On The Risk Options Selected Above. Any Insurance Services And Types Of Cover
Offered By The Mutual Shall Be Subject To: The Rules Of The Mutual Which Shall Govern You And The Mutual, Which Can Be Found At
Www.Mutuallyprotected.Com; The Relevant Cover Description For Each Type Of Cover; And Information About The Mutual’s Insurance
Services Detailed At Www.Mutuallyprotected.Com, Which Shall Each Be Expressly Incorporated Into And Form Part Of Any Insurance Services
And Cover Offered And/Or Provided To You By The Mutual. This Application And The Provision Of Any Insurance Services And Cover By The
Mutual To You Are Subject To Approval By The Mutual.

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Make

covering your business risks easy

We believe that by offering simpler protection and financing solutions through more efficient distribution channels, we can help SMEs survive and thrive. Our solutions couldn’t be simpler to purchase: one click, no paperwork, no hassle.

With MPI you can arrange business risk cover in minutes by buying your policy online. No confusing forms and minimal jargon! Dealing with MPI is straightforward and seamless.

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Premiums/Member

Contribution Levels

Contributions are subject to annual risk assessment based upon the size of the member company, turnover and the sector the business is in. Mutually Protected is a premium value friendly society for SME business, as such meter contributions have a minimum level above £50,000 PA

Making A Claim

We deal with everything direct: no faceless third parties. All claims are handled by
our in-house team personally with a single point of contact.