phone

HOTLINE

700 70 500

Surgical & Hospital Cash Benefit Questionnaire

THANK YOU FOR TAKING THE TIME TO FILL OUR QUESTIONNAIRE!

One of our representatives will contact you at the time you chose.

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PERSONAL INFORMATION

How many additional members of your family do you wish to insure?

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Medical History

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Disclaimer

We will provide you with a quotation based on the information you have provided to us. It is essential that all information and answers are true and accurate and that you also disclose all relevant facts. If you do not provide accurate information and disclose all relevant facts this could lead to your insurance being invalid and claims may not be paid. Pitsas Insurances complies with the principles of GDPR (purpose limitation, data minimisation, accuracy, storage limitation). Your privacy and security is of the utmost importance to us. We will always follow these principles and ask you how you would like us to communicate with you.

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Contact [email protected] or
call us on 700 70 500