Is the property left unoccupied for more than 90 consecutive days?

YesNo

Are your premises protected by an alarm and subject to an annual maintenance contract?

YesNo

Do you have other current policies with Bonnici Insurance Agency / Mapfre Middlesea plc?

YesNo

Have you or any members of your family usually residing with you suffered any loss or damage from any cause within the past 5 years?

YesNo

Do you have other current policies with Bonnici Insurance Agency / Mapfre Middlesea plc?

YesNo

I / We do not have a pre-existing Medical Condition

YesNo

I / we acknowledge that Bonnici Insurance Agency Ltd (BIA) and / or Mapfre Middlesea plc (MMS) may process the personal data that I/we provide in accordance with the Data Protection Act (Cap 440) and with the Data Protection Policy of the Company.

YesNo