Quotation Request Multi Appliance Extended Warranty Client Details 1st Appliance 2nd Appliance 3rd Appliance 4th Appliance 5th Appliance Cover Details Notes Client DetailsProposers Name -- Mr Mrs Miss Ms Dr Prof. Capt. Lord Lady Major Rev. Master Exec(s) of Mx Contact Phone (mobile): Proposers Address UDPRN UPRN Organisation Line 1 Line 2 Town/City County Postcode Enter address manually or Enter address manually Use address lookup How many appliances do you wish to insure:(maximum of five permitted under this policy) 6 1 2 3 4 5 select 1st ApplianceType of Equipment - select - select Entertainment EquipmentKitchen EquipmentLaundry Equipment Type of Entertainment Equipment - select - DVDSky HD BoxTelevision: CRTTelevision: LCD & LEDTelevision: PlasmaZZ-NOT LISTED Type of Laundry Appliance - select - Digital Steam PressTumble DryerWashing MachineZZ-NOT LISTED HERE Type of Kitchen Appliance - select - CookerDishwasherFreezerFridge FreezerMicrowaveZZ-NOT LISTED HERE Entertainment Equipment Manufacturer - select - Bang & OlufsenGrundigPanasonicPhilipsSamsungSonyZZ-NOT LISTED HERE Laundry Appliance Manufacturer - select - BendixElectroluxFisher and PaykelWhirlpoolZanussiZZ-NOT LISTED HERE Kitchen Appliance Manufacturer - select - BendixFrigidaireGeneral ElectricHotpointNEFFZZ-NOT LISTED HERE Year of Manufacture - select - 2006200720082009201020112012ZZ-NOT LISTED HERE Purchase Price £ 2nd ApplianceType of Equipment - select - Entertainment EquipmentKitchen EquipmentLaundry Equipment Type of Entertainment Equipment - select - DVDSky HD BoxTelevision: CRTTelevision: LCD & LEDTelevision: PlasmaZZ-NOT LISTED Type of Laundry Appliance - select - Digital Steam PressTumble DryerWashing MachineZZ-NOT LISTED HERE Type of Kitchen Appliance - select - CookerDishwasherFreezerFridge FreezerMicrowaveZZ-NOT LISTED HERE Entertainment Equipment Manufacturer - select - Bang & OlufsenGrundigPanasonicPhilipsSamsungSonyZZ-NOT LISTED HERE Laundry Appliance Manufacturer - select - BendixElectroluxFisher and PaykelWhirlpoolZanussiZZ-NOT LISTED HERE Kitchen Appliance Manufacturer - select - BendixFrigidaireGeneral ElectricHotpointNEFFZZ-NOT LISTED HERE Year of Manufacture - select - 2006200720082009201020112012ZZ-NOT LISTED HERE Purchase Price £ 3rd ApplianceType of Equipment - select - Entertainment EquipmentKitchen EquipmentLaundry Equipment Type of Entertainment Equipment - select - DVDSky HD BoxTelevision: CRTTelevision: LCD & LEDTelevision: PlasmaZZ-NOT LISTED Type of Laundry Appliance - select - Digital Steam PressTumble DryerWashing MachineZZ-NOT LISTED HERE Type of Kitchen Appliance - select - CookerDishwasherFreezerFridge FreezerMicrowaveZZ-NOT LISTED HERE Entertainment Equipment Manufacturer - select - Bang & OlufsenGrundigPanasonicPhilipsSamsungSonyZZ-NOT LISTED HERE Laundry Appliance Manufacturer - select - BendixElectroluxFisher and PaykelWhirlpoolZanussiZZ-NOT LISTED HERE Kitchen Appliance Manufacturer - select - BendixFrigidaireGeneral ElectricHotpointNEFFZZ-NOT LISTED HERE Year of Manufacture - select - 2006200720082009201020112012ZZ-NOT LISTED HERE Purchase Price £ 4th ApplianceType of Equipment - select - Entertainment EquipmentKitchen EquipmentLaundry Equipment Type of Entertainment Equipment - select - DVDSky HD BoxTelevision: CRTTelevision: LCD & LEDTelevision: PlasmaZZ-NOT LISTED Type of Laundry Appliance - select - Digital Steam PressTumble DryerWashing MachineZZ-NOT LISTED HERE Type of Kitchen Appliance - select - CookerDishwasherFreezerFridge FreezerMicrowaveZZ-NOT LISTED HERE Entertainment Equipment Manufacturer - select - Bang & OlufsenGrundigPanasonicPhilipsSamsungSonyZZ-NOT LISTED HERE Laundry Appliance Manufacturer - select - BendixElectroluxFisher and PaykelWhirlpoolZanussiZZ-NOT LISTED HERE Kitchen Appliance Manufacturer - select - BendixFrigidaireGeneral ElectricHotpointNEFFZZ-NOT LISTED HERE Year of Manufacture - select - 2006200720082009201020112012ZZ-NOT LISTED HERE Purchase Price £ 5th ApplianceType of Equipment - select - Entertainment EquipmentKitchen EquipmentLaundry Equipment Type of Entertainment Equipment - select - DVDSky HD BoxTelevision: CRTTelevision: LCD & LEDTelevision: PlasmaZZ-NOT LISTED Type of Laundry Appliance - select - Digital Steam PressTumble DryerWashing MachineZZ-NOT LISTED HERE Type of Kitchen Appliance - select - CookerDishwasherFreezerFridge FreezerMicrowaveZZ-NOT LISTED HERE Entertainment Equipment Manufacturer - select - Bang & OlufsenGrundigPanasonicPhilipsSamsungSonyZZ-NOT LISTED HERE Laundry Appliance Manufacturer - select - BendixElectroluxFisher and PaykelWhirlpoolZanussiZZ-NOT LISTED HERE Kitchen Appliance Manufacturer - select - BendixFrigidaireGeneral ElectricHotpointNEFFZZ-NOT LISTED HERE Year of Manufacture - select - 2006200720082009201020112012ZZ-NOT LISTED HERE Purchase Price £ Cover Details Total Premium (Net) £0.00 + IPT @ % £0.00 + Policy Fee £ £0.00 Total Premium £0.00 Total Commission £0.00 (Due From Broker) £0.00 Additional NotesAdditional Notes