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Martin House
101 High Street
Rochester, Kent, ME1 1LX
Tel: 01634 407103
Fax: 01634 826573
Contact : ian.martin@mislonline.com
sean.still@mislonline.com

Welcome to Martin Insurance Services. A professional solution for all your insurance needs

Application Form

GENERAL QUESTIONS
Customer Vehicle Worked On
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
OWN VEHICLE DETAILS
COVER
Comprehensive
Third Party, Fire & Theft
Yes
No
Windscreen Excess
DRIVERS
LIABILITY
Yes    No
MATERIAL DAMAGE (to be completed if you require cover at your premises)
  Home
  Business

Construction Are all walls (including Frame Work) incombustible i.e of brick, stone, concrete or asbestos?

  Yes
  No

Are all roofs constructed of slate, tile, concrete or asbestos (with no more than 20% of the total roof area being mineral felt over timber)?

  Yes
  No
BUSINESS INTERRUPTION
GOODS IN TRANSIT
Commercial Legal Expenses
Motor Legal Expense Only
Please supply the following information:
Are you a member of any of the following?
IFITSUFF
THATCHAM
Mobile Electrical & Security Federation

Martin Insurance Services Ltd are authorised and regulated by the Financial Conduct Authority.
Registered in England - 3187620. Registered address: 160 Church Street, Cliffe, Nr Rochester, Kent, ME3 7QB