Stubben Edge Markets

Individual's and Policy Details

First Name *

Last Name *

Email *

Personal Contact Number *

Home Address Postcode *

House Name or Flat Number

Applicant Address 2

Applicant Address 3

Applicant Address 4

Applicant Town *

Applicant County

Applicant Country *

Cover Effective Date (Effective Date cannot be backdated) *

Can we contact you by Email? *

No

Yes

Can we contact you by SMS? *

No

Yes

Can we contact you by Telephone? *

No

Yes

We may use your personal information to tell you about relevant products and offers. This is what we mean when we talk about ‘marketing’.

We will only contact you for marketing purposes if you have provided your explicit consent for us to do so. Would you be happy for us to contact you? *

No

Yes

You can withdraw your consent at any time by emailing: info@sidebysideinsurance.co.uk

Security Questions

It is important that if you call, we can be sure that we are actually speaking to you and not someone pretending to be you. For this reason, we ask that you provide the answers to the following security questions:

Date of Birth *

Place of birth *

Membership

Are you a member of any Associations? *

No

Yes

Membership List

Membership Other

Residence in the UK excluding Northern Ireland.

Type of property? *

Do you live in tied accommodation? *

No

Yes

Tied Accommodation Details

Existing Licenses

Do you have a UK driving license? *

No

Yes

Have you ever held a UK driving license?

No

Yes

Do you have any current convictions? *

No

Yes

Driving Conviction Date

Description

Outcome

Driving Conviction Date

Description

Outcome

Driving Conviction Date

Description

Outcome

Driving Conviction Date

Description

Outcome

Driving Conviction Date

Description

Outcome

Firearm Certificate Held *

When does your Shotgun certificate expire?

When does your Fire arm certificate expire?

Shooting Activity

Does your livelihood depend to any extent on your holding a firearm or shotgun certificate? *

No

Yes

Medical

Were all medical conditions, if any, declared during your gun license application? *

Convictions

Since the granting of your current shotgun or firearms license, have you been cautioned or convicted of any offence?(List all Convictions/Cautions) *

No

Yes

Conviction/Cautioned Date

Description

Outcome

Conviction/Cautioned Date

Description

Outcome

Conviction/Cautioned Date

Description

Outcome

Conviction/Cautioned Date

Description

Outcome

Conviction/Cautioned Date

Description

Outcome

Have you even received a warning letter in relation to your holding of a shotgun or firearm certificate? *

No

Yes

Please provide details or a copy?

Have you ever been refused the grant of a shotgun certificate, had conditions imposed on a firearms *

No

Yes

Please provide details

Do you know of a circumstance that could lead to a conviction? *

No

Yes

Type

Date

Type

Date

Type

Date

Type

Date

Type

Date

Claims History

Are you aware of any claims or circumstances that may give rise to a claim under this policy *

No

Yes

Please provide details

Do you want Side to contact you to discuss your quote?

No

Yes

Create New Side By Side Quote

Individual's and Policy Details

Security Questions

It is important that if you call, we can be sure that we are actually speaking to you and not someone pretending to be you. For this reason, we ask that you provide the answers to the following security questions:

Membership

Residence in the UK excluding Northern Ireland.

Existing Licenses

Shooting Activity

Medical

Convictions

Claims History