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If you are an existing client of ours and have received a renewal invitation from us to renew your insurance cover you can provide us with your renewal instructions by completing this form.

On receipt of the completed form we will renew your policy, prepare the renewal documentation and send this out to you with the relevant invoice for payment.

Please note

  • This form cannot be used to amend your policy. It can only be used to confirm that you wish to renew your policy.

  • This form cannot be used to renew a policy if the renewal date has already passed.  

To discuss renewing a policy after the renewal date has passed or to discuss any changes needed to your policy call our team on 01473 216406, Monday to Friday between 9am and 5:30pm.

Name *
Company *
Email *
Phone number *
Client reference *
Renewal date *

I would like to renew my policy on the following basis:

Select Premium

 *

Renew as per the renewal invitation you have sent me

Renew at a different premium as already agreed with Pound Gates

     

Please confirm your preferred payment method

 

 *

Cheque

 
Direct Debit with Premium Credit Ltd

 

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