Lloyd's Accident or Accident and Illness Proposal Form

    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question

    Compensation payable in respect of ACCIDENT

    Captionless Image

    The policy includes medical expenses up to 15% of the total amount of any claim paid for temporary total or temporary partial disablement, without additional premium.

    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question

    Copy of crew manifest needed

    Please email us (info@darlowinsurance.com) separately a copy of the crew manifest as it is required.