PSD2 Insurance Quotation

Please complete this short Statement of Facts to receive your individual insurance quotation.

If you would like to learn more about the insurance coverage visit PSD2 Insurance.

 

Statement of Facts

Completion of this proposal does not bind the undersigned to purchase or the insurer to issue a policy

Please complete the proposal form for all entities for which cover is required under this policy and confirm that:

  • To the best of your knowledge and belief, the information provided by you or on your behalf including the statements set out below are true, accurate and complete; and
  • You have disclosed all information relating to you or your business that is material to your application.
  • 1. Your Contact DetailsEdit
  • 2. Your companyEdit
    • E.g. www.example.com

    • Please enter numbers only.

    • Please enter numbers only.

    • Please enter numbers only.

    • Please enter numbers only.

    • Please enter numbers only.

  • 3. Business activitiesEdit
    • If you are applying for PISP permissions then please confirm:

    • Please enter numbers only.

    • Please enter numbers only.

    • Please enter numbers only.

    • If you are applying for AISP permission then please confirm:

    • Please enter numbers only.

    • Please enter numbers only.

  • 4. Statement of FactsEdit
    • In providing the Information in the Statement of Facts, you confirm that it is accurate whether it has been provided by you or others on your behalf.

      Ensure that you read the questions and confirm that all facts are accurate and complete.  If any information provided needs amendment then you must inform us before the start of the period of insurance.

      If there are any changes to the information during the period of insurance please inform us immediately and we will then notify you if this affects your policy.  If you do not inform us of any changes it may affect any claim you make or result in your insurance being invalid.

      Please agree or disagree with the following points (note, when we say "you", we refer to the proposed insured company"):

  • 5. Cover RequirementsEdit
    • Please advise the limit of indemnity for which you require a quotation by ticking the relevant boxes. If you would like us to provide options e.g. £1m and £2m, then please choose £specify and put the options you require in the freetype box.

  • 6. Claims ExperienceEdit
    • Can you please provide further information in respect of each claim, investigation or loss:

      1) Date

      2) Brief description of the nature of the claim, investigation or loss

      3) Values of any payments made or current estimate of loss

      4) Measures taken to prevent a reoccurence

    • Help

      .zip or .pdf extensions only. Max allowed size is 10MB.

  • 7. DeclarationEdit
    • Material information

      It is your duty to disclose all material facts to insurers. A material fact is one which may influence an insurer’s judgement in its consideration of your proposal. If any of the statements above are incorrect, you must contact Protean Risk and ensure that they pass that information on to Insurers immediately. Insurers reserve the right, in accordance with the terms of your Policy, to amend the Premium and/or terms and conditions or cancel your Policy if there is a material inaccuracy in this information.

      Your information

      Here at Protean Risk we take your privacy seriously and will only use your personal information to provide your PSD2 insurance quotation and for our legitimate business interests. Click here to learn more about these interests and when we may process your information in this way.

      We will never share, rent or pass your information to any third parties other than insurance companies quoting for and providing your PSD2 insurance and only then when you have specifically instructed us to seek insurance terms or obtain insurance cover on your behalf.

      Next steps

      Protean Risk will provide a quotation based on your responses but we will require some additional information in order to put the insurance in place and you will be advised of this with our quotation.

    • Please enter your initials.