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Personal  Information

 Title  Name *  Surname *  ID Number * Age Occupation *
Postal Address
 E-Mail Address * Tel No. - Home Mobile Tel No. - Office
Address of Property to be insured

 



Please specity the sum insured for your buildings?

Please specity the sum insured for your contents?

Would you like to insure your valuables on an All Risk Basis? (Valuations will be required to substantiate values to be insured)

Yes   No
If yes, Please specify the total amount of valubles:

Would you like a quotation for a Personal Accident cover?
Yes   No

Do you have a motor vehicle insured with us?
Yes   No

Is your house protected with a burglar alarm?
Yes   No

For how many consecutive days will the building to be insured be left unoccupied during the year ?

Are you presently insured?
Yes   No

Have you had any claims in the past 5 years?
Yes   No

How would you like to recieve your quotation?

Post
Fax E-Mail

 

Data Protection Notice

To the extent that the information supplied by you, whether orally or in writing, constitutes personal data, including sensitive data within the provisions of the Data Protection Act, you consent to the processing of such data for purposes of administering your proposal for insurance, your Policy, underwriting, handling of claims and also for the purposes of detecting, preventing and suppressing fraud and of keeping statistics. We maybe required to collect further information from our sub-agents, other insurance companies, insurance intermediaries or insurance associations.

In addition, we may pass some or all of the information to other insurance companies, or insurance associations for underwriting and claims handling purposes and also for the purposes of detecting, preventing and suppressing fraud and of keeping statistics. This also helps us to check the information provided. When we deal with your request for insurance, we may search this information. When you tell us about an incident which may or may not give rise to a claim, we will pass information relating to it to the Malta Insurance Association.

We and other companies within our group would like, on occasion, to keep you informed of our products and services, by mail, fax, e-mail or other electronic means. Please inform us in writing if you do not wish to receive this information or if you wish to receive such information solely from GasanMamo Insurance Ltd. Moreover, were hereby ask you whether you wish to receive direct marketing information from us by e-mail to your e-mail address provided below.

You have the right to request access to, and rectification of, your personal data held by us by directing your request in writing signed by yourself to the Data Protection Officer, GasanMamo Insurance Ltd, Msida Road, Gzira GZR 1405

 

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GasanMamo Insurance Limited is authorised to carry on business of insurance in Malta in terms of the Insurance Business Act 1998, regulated by the Malta Financial Services Authority. Company Registration Number: C3143