Personal Accident Insurance Application

Your price

£- per month

Key Information

Please read these documents before proceeding further

Policy Document

Insurance Product Information Document (IPID)

Terms of Business

Throughout the application journey we will provide you with key information(Policy Document, Insurance Product Information Document (IPID)) about the Personal Accident Insurance product electronically. If you prefer to receive this information by paper please call us to discuss.

You can choose whether you’d like to receive your policy documents by paper or email in the application.

Our application tool can help you work out your Personal Accident Insurance needs and will be based on the information you provide. You'll be able to tailor your cover through completing the application. We will not give you a personal recommendation and this should not be considered as advice.

Eligibility

You must be a serving member of H.M. Forces and aged under 65 years of age.

Yes
No
Please answer this question
Please select an option

Your cover:

Please enter a valid start date (dd/mm/yyyy) in the next 30 days
Individual
Family
Monthly price per unit:
1
2
3
4
5
Individual Cover
£5.04
£10.08
£15.12
£20.16
£25.20
Family Cover
£6.16
£12.32
£18.48
£24.64
£30.80
Maximum Benefit Payable
£30,000
£60,000
£90,000
£120,000
£150,000
The benefit paid depends on the injury and there are exclusions/terms that apply. Full table of benefits can be found in the Policy Documents – please read these before continuing.
1
2
3
4
5
Next

All fields are required, unless stated.

Please select a title
Please enter your first name
Please enter your last name
Please enter your date of birth (dd/mm/yyyy), you must be aged between 16 - 65 years old to take out a policy.
Please enter your email/amend address
Please enter your contact number

Address

Look up

Or, enter your address manually

Please enter your address
Next

Please answer yes or no to all options.
Next

PMGI Limited (Forces Mutual) is committed to respecting and protecting your personal data. This section sets out what we will do with your information and explains your rights.

The information you have supplied will be used by Forces Mutual to provide you with a quotation and administer your Personal Accident insurance policy if you choose to proceed. We will also share your information with Motorplus Limited t/a Coplus and Astrenska Insurance Limited who underwrite the policy.

Click on the links below to find out more:
How we will use the information we collect?
Who and why might we share your information with?
What precautions do we take to protect your information?
How long do we keep hold of your information?
Yours rights
Complaints

To view our full privacy policy click here

If you have any questions about our privacy policy, you can contact our Data Protection Officer directly at datacontroller@bspokegroup.co.uk or by writing to them at: 4th Floor, 24 Old Bond Street London, W1S 4AW

Next

The price and cover details for your chosen policy are shown below. If you are happy with this, have read the policy documents and are happy this cover meets your needs then you can proceed to take out the cover by completing the Direct Debit payment details below.
To set up your direct debit online you must be the account holder and able to authorise debits from the account.

Your price

You have selected the policy with of cover, which would have a maximum benefit payable of per insured person.

£ per month
(This includes Insurance Premium Tax)

Demands and needs

In choosing this product and the level of cover, you have not received any personal recommendations from Forces Mutual, Coplus, or any other insurer.

Personal Accident Insurance is arranged by Motorplus Limited t/a Coplus and underwritten by Astrenska Insurance Limited.

Personal Accident Insurance – this product meets the demands and needs of someone who wants protection in the event of permanent injury, disablement or accidental death. Cover is provided in accordance with the policy terms and conditions.

You can save and print this information here.

Payment details

Please enter payment information below. Following this tab there will be a final page to agree to our Declaration before submitting for first payment.

Please answer this question
Please enter valid bank account details

The premium will be collected on the first available 1st or 15th of the month. All subsequent collections being collected on the 1st of the month.

Instruction to your Bank or Building Society

Please pay PMGI Ltd direct debits from the account detailed subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with PMGI Ltd and, if so, details will be passed electronically to my Bank / Building Society.

To see the direct debit mandate and guarantee, please click here
Next

By completing your Personal Accident Insurance policy purchase, you are confirming you have read and agree that the following statements below are correct:

  • I understand the content of this completed online application form and I wish to proceed to buy a policy;
  • I confirm that the information I've provided is correct and accurate to the best of my knowledge and understanding;
  • I agree that if the information I've provided should change after I have purchased the policy and during the period of the policy, that I will let Forces Mutual know. (Changes include change of address, cover level and eligibility status as a member of HM Forces or equivalent Ministry of Defence or affiliated organisation);
  • I accept that if the information provided by me is not correct and accurate, my policy may be cancelled or treated as if it never existed, and/or the insurer may refuse to pay all or part of any claim, or it may revise the premium, and/or change any excess, or the extent of the cover;
  • I agree that if the application is accepted, I understand I must pay the monthly premiums for the policy to remain in place;
  • I confirm that I meet the eligibility criteria; as a UK citizen under 65 and a member of HM Forces or equivalent Ministry of Defence or affiliated organisation;
  • I am aware and agree that the premium will be collected on the first available 1st or 15th of the month. All subsequently collections being collected on the 1st of the month. I understand that premiums will be payable until either I or Forces Mutual cancel the policy;
  • I agree that this product matches my demands and needs of providing protection in the event of permanent injury, disablement or accidental death. I understand cover is provided in accordance with the policy terms and conditions;
  • I understand that when I receive my insurance documents, I have 14 days to change my mind and cancel my cover and have my payments refunded (if no claims are made).

It is important you understand all of the Key Information for Personal Accident Insurance and check the cover you are buying to ensure that it meets your needs. We recommend you read all of the policy documents including the Insurance Product Information Document (IPID) before you continue, and keep them in a safe place.

You should also read the Our Terms of Business as this provides important information about our service.

Please confirm the above before submitting
Please select an option

Thank you for completing the application. Please now press the Submit button to activate your payment and set up your Personal Accident Insurance policy