Trafalgar International have developed schemes with a number of underwriters who are prepared to offer a VIP service on personal insurance arrangements. We have also negotiated with these insurers very broad cover and highly competitive premium terms.

If you would like to obtain a premium quotation by return e-mail, simply complete the following details and push 'Submit':

About You

Full Name
E-Mail (Required)
Home Address
Occupation
Business Address
Phone	Home		Office
Fax	Home		Office
Age	You		Your Spouse
Nationality	You		Your Spouse

About Your Property

Address (if different from above)
State the type of property	Please Select Detached House Town House Apartment
Is the property occupied throughout the working day ?	Yes No Please Select
Is the property constructed of brick, stone or concrete and roofed with slate, tile or concrete?	Yes No Please Select
Has the property or the immediate vicinity suffered from flood?	Yes No Please Select

If you do not own your home, our policy will provide tenants liability cover for accidental damage you cause subject to a limit of Baht 500,000.- and a deductible of Baht 5,000.- provided you insure your household contents.

Your Insurance History

Are you presently insured against loss or damage to your property? If “Yes” please state the name of the insurer.		Yes No Please Select	Name of Insurer
Has any insurer declined to provide you with insurance? If “Yes” please give details.		Yes No Please Select	Details
Have you ever made a claim under a fire, burglary or household policy? If “Yes” please give details.		Yes No Please Select	Details

Your Period of Insurance

When do you want the insurance to start?
(Cover will only commence after we have issued formal acceptance and will renew on the nearest quarter day.)

Day 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st

Month January February March April May June July August September October November December

Year 1999 2000 2001 2002 2003 2004 2005

Section 1 : Your Home

If you own the building of your home, you should complete this section. In the more likely event that you or your company are renting your home, you may still be liable for damage that you cause to the building. Insurance for such legal liability is provided automatically if you buy section 2 of the policy. The automatic cover for such tenant's liability is limited to Baht 500,000.-, is subject to a deductible of Baht 5,000.- and is limited to damage caused by fire, explosion and overflowing of water apparatus only.

This section of the policy provides insurance cover for the Building against the risks of fire, lightning, explosion, windstorm, water damage, flood, earthquake, impact by road vehicles, impact by aircraft or articles dropped therefrom, riot, strike, malicious acts and bush-fire.

Cover is on a new for old basis with no deductions being made from claims settlements for wear, tear and depreciation. However, it is essential that the sum insured represent the full cost of rebuilding as new if you are to receive a full settlement in the event of a loss. If you need advice on rebuilding costs, please us.

The premium will be calculated at a rate of Baht 2.- per Baht 1,000.- of sum insured.

Do you own the building of your home?	Yes No Please Select
If so what is the full cost for rebuilding as new?	Thai Baht

Section 2 : Your Home's Contents

This section provides insurance cover for the furniture fixtures and fittings in your home and for those items of personal effects, which are confined to your home. Cover may also be extended to include your landlord's furniture, fixtures and fittings, if you are responsible for them under the terms of your lease.

The cover is on an "All Risks" basis and extends to include theft and accidental damage as well as those perils covered under Section 1. All policies contain exclusions however and you should refer to the policy document for full details.

Cover is on a new for old basis with no deduction for wear and tear. However it is essential that the sum insured represent the full value at risk if you are to receive a full settlement of any loss. A check list is attached to help you calculate the correct sum insured.

The premium is calculated at a rate of Baht 7.50 per Baht 1,000.- sum insured if you live in a house or at a rate of Baht 6.- per Baht 1,000.- sum insured if you live in an apartment. These rates may be significantly reduced for sums insured in excess of Baht 2,000,000.-.

Do you wish to insure the contents of your home?	Yes No Please Select
If so what is the full cost of replacement as new?	Thai Baht

Please list details of any curio, work of art or other item of jewellery that exceeds Baht 25,000.- in value and which is not separately insured below under the Personal Effects. Unless listed, the maximum liability of the insurer is limited to Baht 25,000.- for any one item.

Description	Value (Baht)		Description	Value (Baht)

Section 3 : Alternative Accommodation

This section provides insurance for the reasonable additional cost of hotel accommodation incurred in the period necessary to restore your home to a habitable condition following damage to your home caused by the risks of fire, lightning, explosion, windstorm, water damage, flood, earthquake, impact by road vehicles, impact by aircraft or articles dropped therefrom, riot, strike, malicious acts or bush-fire.

Cover is provided free of charge when you purchase cover under Section 2 of this policy.

Do you wish to cover the cost of alternative accommodation?

Yes No Please Select

Section 4 : Your Personal Effects

This section provides insurance cover for any personal effects, clothing, jewellery, sports goods and other items, which are regularly removed from your home. Cover is on an "All Risks" basis as described under Section 2 and extends to include accidental loss. However any claim for theft, accidental damage or accidental loss outside of your home is subject to a deductible of Baht 2,000.- for each claim. Cover is on a new for old basis with no deduction for wear and tear.

A valuation or receipt is required in respect of any item of jewellery valued in excess of Baht 25,000.- in order that claims can be settled quickly when a loss occurs. Without such evidence of value, the maximum liability of the insurer is limited to Baht 25,000.- for any one item.

Cover for mobile phones, pagers and laptop computers is subject to a 33.3 % co-insurance by you. This means that you will pay one third of any loss incurred.

The premium is calculated at a rate of Baht 9.- per Baht 1,000.- sum insured if you wish to restrict cover to Thailand only or Baht 12.50 per Baht 1,000.- sum insured if you require cover on a world wide basis. However, mobile phones, pagers and laptop computers are subject to a higher rate of .-Baht 20 per Baht 1,000.- sum insured.

Please complete the following for all items to be insured.

Item	Description	Date of Purchase	Value (Baht)
1
2
3
4
5
6

Section 5 : Your Personal Liability

This section provides insurance cover for your legal liability for injury or damage which you may cause to members of the public subject to a limit of Baht 10,000,000.-. Cover is provided free of charge when you purchase cover under Section 2 of this policy.

Do you wish to insure your personal liability?

Yes No Please Select

Section 6 : Workmen's Compensation

This section provides insurance cover for your legal liability for injury or damage, which you may cause, to your own domestic servants and drivers. Cover is provided free of charge when you purchase cover under Section 2 of this policy.

Do you wish to provide Workmen’s Compensation Insurance for domestic staff?

Yes No Please Select

Section 7 : Personal Accident

You are away from home. Money is not readily available. You are seriously injured or killed in an accident.

An unpleasant scenario to imagine- we know - but can your dependents get immediate access to funds for medical expenses, emergency flights or even regular expenses such as rent, school fees etc.? Personal accident insurance is an inexpensive way to provide additional emergency funds while you are overseas.

This section provides insurance cover for any personal accident to you or your spouse. In the event of an accident leading to death, loss of limbs or eyes or other permanent total disablement, a lump sum will be paid to you in accordance with the level of benefit you have indicated on this form.

If you are involved in administrative and managerial duties only, cover applies on a 24 hours per day basis. If you are involved in other duties, cover may be restricted to off-duty hours only. Please provide as much detail as possible regarding your occupation. The premium is charged at a rate of Baht 1.25 per Baht 1,000.- sum insured.

Please state level of cover required (Thai Baht)	Self	250,000.- 500,000.- 1,000,000.- 2,000,000.- Please Select	Spouse	250,000.- 500,000.- 1,000,000.- 2,000,000.- Please Select
Who do you wish to receive funds in the event of your accident?		Self Spouse Please Select
If you wish to provide cover for your spouse, please state name in full

Section 8 : Hole in One

A standard “Golfer’s Policy” will provide cover for loss or damage to your golf clubs, liability you may incur on the golf course if you accidentally injure anyone and personal accident insurance in case you injure yourself. These three areas are covered under separate sections of our policy: Section 3 - Personal Effects, Section 4 – Personal Liability and Section 5 – Personal Accident. This section provides for those traditional celebrations at the 19^th hole when you share your success. Celebratory drinks are covered up to a maximum of Baht 5,000.-. Any “hole in one” must of course be attested to by at least one witness and certified by the golf club manager.

A flat premium of Baht 50.- is charged.

Please confirm whether cover is required

Yes No Please Select

Section 9 : Other Insurances

We can also provide cover for a range of other insurances.
Please advise if you would like to receive details of the following:

Motor Insurance	Yes No Please Select
Yachts and Pleasure Craft Insurance	Yes No Please Select
Travel Insurance	Yes No Please Select
Health Insurance	Yes No Please Select
Corporate Insurance Programmes	Yes No Please Select

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