Quote Request

  • Sportscover transacts business via specialist insurance brokers worldwide.
    Quote requests made via this website may be handled via your nearest Sportscover accredited broker.
     
  • We have tried to make the quote request input as simple as possible. When entering numbers, please do not use spaces, a currency sign, %, comma, hyphens or decimal places. Always enter whole numbers only.
     
  • Asterisks (*) denotes compulsory input fields.

Sportscover Professional Accident Insurance

* Contact Name:
* Organisation Name:
* Postal Address:
* Suburb/Town:
* Postcode/Zipcode:
* State/County/Province:
* Country:
Phone no:
Fax no:
Email Address:
* Sport:
* Period of Insurance:
Details of Insurance Required:
Date of Birth:
Team:
League:
Position Played:
Estimated 12 months basic income
from your sport (excluding bonuses):
Are you currently free of injury
and playing for your team:
Have you during the last 12 months missed more than TWO consecutive games due to injury or illness:  
If so, enter dates, reason(s) and total number of games missed:
Are you now and have you been perfectly well and in sound health for the year proceeding this application?  
Have you consulted a doctor during the past two years?
If so, please give dates, and for what reason(s):
Have you had any X-rays, CAT Scans or MRI Scans in the last 24 months?
If yes, dates, reasons, ailment(s) and/or medical conditions:
Have you any physical defect or infirmity?
If yes, please give particulars:
Have you, during the last TWO years, taken a course of pain reducing or anti-inflammatory medication for a period exceeding THREE weeks?


If so, please give details:
Is your sight in any way impaired; have you ever suffered from any disease of the eyes?
If so, please give details:
Is your hearing impaired; have you ever had any discharge from the ears?
If so, please give details:
Have you ever suffered from Appendicitis, Asthma, Blood Pressure, Blood-spitting, Diabetes, Dyspepsia, Fits, Gout,Hernia, Paralysis, Piles, Rheumatism, or any Rheumatic Infection, Skin Infections, Varicose Veins,or any Diseases or Disorders of the chest or Respiratory System, Heart, Stomach or Nervous System?






If so, please give dates and state if operation performed:
Have you during the past FIVE years had any other operation or suffered from any other illness or accident?

If so, please give dates details:
Have you any reason to think that you may need to undergo a surgical operation in the future?

If so, please give dates details:
Are you now insured against accident or illness?
ø
If so, with whom, and for what benefits?
Have you at any time been insured against accident or illness?
ø
If so with whom?
ø If you answered YES to either of the previous two questions, please advise if you have any claims in respect of accident or illness. Please state in each case the nature of your claim, amount and name of Company or Underwriter:
Have you ever been declined, or accepted on special terms, for Lif Insurance or or Insurance against Accident or Illness (for example, with specially agreed exclusions)?


Has any Company or Underwriter ever cancelled or declined to renew your policy?
Do you engage in any sport(s) as a professional other than the sport which is nominated in this insurance?

If so, please give details:
Claims History
* Have you had any claims
in the past 3 years?
If you clicked "YES" in the
previous question, please
give details of claims:
Any other Relevant Information:
* Prefered Insurance Broker:
Find your nearest broker (opens in new window).