We provide a non-advised service and will give you key information on the features as well as the limitations/exclusions of the policy. This will help you make an informed decision about our products and services. Full details will be made available to you throughout the quotation. If you have questions about the policy terms and conditions, please call our team.

The personal data you provide us within this form will be retained to provide you with information about your quote. Our Privacy Notice lets you know how we look after your data.

Please complete the following details.

Employer Details The employer is the person or organisation responsible for the hiring of the carer and paying their wage

Company name

(If applicable)

Title

First name

Last name

Phone number

Address

Enter address manually

Please note:
1. We are unable to cover anyone who resides in the Channel Islands.
2. If you reside on the Isle of Man, please contact us for a quote.

Use this address for payment

Date of birth

How did you hear about Carer Insure?

Agency name

Employer 2

Company name

(If applicable)

Title

First name

Last name

Phone number

Address

Enter address manually

Please note:
1. We are unable to cover anyone who resides in the Channel Islands.
2. If you reside on the Isle of Man, please contact us for a quote.

Use this address for payment

Date of birth

If you don't want to add another employer to your policy,
please continue to the next section. A maximum of 2 employers can be added.

Details of the Person(s) Receiving Care (Care User)

Important: We are able to insure up to 4 people on the same policy, however all care users need to live at the same address and must be directly related to each other or legally married. For example, brothers, sisters, husband and wife.

Person 1

Title

First name

Last name

Phone number

Address

Enter address manually

Please note:
1. We are unable to cover anyone who resides in the Channel Islands.
2. If you reside on the Isle of Man, please contact us for a quote.

Use this address for payment

Date of birth

If you have added all your care users, please continue to the next page by clicking Next below.