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Personal Accident Insurance Quotation

Pro Admin is a Registered Financial Service Provider. FSP no 1234

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This quotation is provided strictly on the information supplied by the proposer. The details furnished at the quotation stage form the foundation of the insurance policy and will be relied upon by the Insurer. Any misrepresentation, omission, or non-disclosure of material facts may result in the rejection, reduction, or repudiation of any future claim, and may render the policy voidable at the option of the Insurer. If you are uncertain about any information requested, please provide full details in the remarks section. By accepting this quotation, it will be deemed that you have read, understood, and accurately completed all applicable sections of this form.
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I/we hereby declare that the information provided is correct and accurate. By ticking the agree button you consent to the insurers/broker to process your personal information to provide the quotations. Processing includes sharing/collecting your information with insurers and with a registered credit bureau. The information will only be used to enable the insurers to quote more accurately.