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Application form
Middlesea offers tailor-made advice to its customers looking for business insurance. Please complete the Enquiry Form below and we will be in touch with you.
Contact Details
Title (Mr/Ms/Dr)    
First Name   Last Name
Address Telephone
Fax Email address
Business/Occupation

Business Details
Company Name   No of Employees
Address    
 
Business Insurance Required
Commercial Plan
Electronic Equipment Insurance
Public Liability
Employers Liability
Contractors All Risks Policy
Motor Commercial Insurance
Commercial Fleet Insurance
Hoteliers Combined Insurance Policy
Marine Cargo
Yachts and Pleasure Craft
Fire
Theft
Money
Group Health
Group Life
Group Personal Accident

  Other: Please specify  
Do you have other current policies with Middlesea Insurance p.l.c.?
  Yes  No
If YES please give Policy Number(s) 
Comments

 I/we acknowledge that Middlesea Insurance p.l.c. (MSI) 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.
 I/we acknowledge that I/we have a right to request to and rectification of such data as processed by MSI. Any such request must further be signed by myself as the applicant/joint assured/joint holder to whom the personal data relates.

We would like to keep you updated with our latest products & services. Your details will not be passed on to any third parties.

If you do not want to receive this information please tick this box 
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Middlesea Insurance p.l.c.
Middle Sea House
Floriana, FRN1442
Malta
Tel: (+356) 21246262
Fax: (+356) 21248195
  
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Middlesea Insurance p.l.c. is a company authorised under the Insurance Business Act, 1998 to carry on both Long Term and General Business and is regulated by the Malta Financial Services Authority.Registration Number: C5553. 

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