Please complete all the mandatory fields marked with an *
* Title:
* Full Name:
* DOB:
* Address1:
* Address2:
* City:
* County:
* Country:
* Postcode:
* Telephone:
Mobile:
* Email:
Method Of Contact:

CONDITIONS OF POLICY: Equipment must have been purchased new in the UK from a recognised retailer or manufacturer direct. Insured must be able to produce an original purchase invoice in their name ( important must be their name) no claim will be considered without this Only 1 laptop or PDA can be insured under each policy (2 laptops 2 policies)
* Laptop Value	£
* Laptop Make:
* Laptop Model:
* Serial Number:
Date of Purchase (Laptop must be less than 6 months old or insurance cover will be invalid):
* Start date of cover DD/MM/YY. Should not be more than 30 days in advance. Cover start date cannot be backdated or insurance cover will be invalid.:
I declare that I have not made a computer claim in the last 3 years	No, I have not made a claim in the past three years Yes, I have made a claim in the past three years
I have read and accept the Terms & Conditions and have viewed the Policy Document and Guide to Laptop Security
View Policy Document \| View ClickCovers's Guide to Laptop Security \| View KeyFacts