Fast hassle free application process!
Simply complete the form below and let us do the rest!
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Remember - there is no obligation, you can pull out at any time for any reason without penalty.
Security Note
: Please also be assured that your details will remain entirely confidential.
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Personal Details:
Applicant 1
Title:
- Mr.
- Mrs.
- Ms.
- Miss
- Other
First Name:
Last Name:
Date of Birth:
Smoker / Non Smoker
-Smoker
-Non Smoker
Income: £
Daytime Telephone:
Evening Telephone:
Mobile Number:
Email Address:
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House Name/Number:
Street Name:
Town:
County:
Postcode:
Employment Status:
Employed
Self Employed
Un-employed
Applicant 2 (if applicable)
Title:
- Mr.
- Mrs.
- Ms.
- Miss
- Other
First Name:
Last Name:
Email Address:
Insurance Requirements:
select the insurance products you are interested in.
Mortgage Protection:
Level Term Assurance:
Accident Sickness & Unemployment
Permanent health Assurance:
Critical illness Assurance:
Buildings & Contents Insurance:
Travel Insurance :
Indemnity & Liability Insurance
:
Landlord Insurance (Rent and Legal Protection):
Full Tenant Assessment Facility:
Other Details:
How did you find out about us?
- Internet Search Engine
- Advert in the Paper
- From a Friend
- Other
Data Protection Notice:
DATA PROTECTION ACT 1998 I/we confirm that I/we have the consent of any third party whose details I/we may disclose to The Cooper Partnership ("You") to disclose such details and to authorise You and the third parties referred to in the paragraph below to process such details for the purposes of assessing my/our application and administering and enforcing any subsequent loan which may be granted to me/us. I/we agree that You and any lender resulting from this application (the "Lender") shall be entitled to use and process, by any medium, the information given by me/us in this application form and any other information about me/us which may be acquired during the lifetime of any loan ("the Data") for the following purposes:- i. To provide the Data to and search the files of one or more credit reference or fraud prevention agencies whether before, or during the lifetime of any loan granted to me/us by the Lender, who will keep a record of such search, to confirm the Data, and for the purposes of credit assessment or account administration. I/we understand that You and /or the Lender will record false or inaccurate information if this is given by me/us and fraud is suspected. ii. To disclose the Data to credit reference agencies when requested by them for consideration of any future applications for finance made by me or members of my household/family, or for fraud prevention and/or tracing debtors (the agencies may also disclose the Data to other lenders for these purposes) iii. To disclose the Data to any other company within the Lender's group of companies and/or to any third parties (for example, debt counsellors and insurers) at any time for the purposes of assessing my/our application and administering and enforcing any subsequent loan whether during the course of my/our application or during the lifetime of any loan granted pursuant to such application; iv. To disclose the Data to any third party who replaces or who may replace my/our Lender. PREVENTION OF MONEY LAUNDERING The Lender and other organisations may use and search the records of credit reference or fraud prevention agencies to check your identity to prevent money laundering, unless you have furnished other satisfactory proof of identity. RIGHT OF SUBJECT ACCESS Information held by us will be processed only for purposes for which we have registered under the Data Protection Act. Upon you making a request in writing we will provide you with a copy of the information which we hold concerning you on payment of a fee. PERSONAL DETAILS AND DATA PRIVACY The personal details which you submit to us (Personal Data) are held by The Cooper Partnership for its own use. It is your responsibility to ensure that your Personal Data is accurate and up to date and to inform us of any changes that need to be made. The Cooper Partnership may use the Personal Data for the purposes they have notified to the Office of Information. By submitting your Personal Data you CONSENT to it being processed by The Cooper Partnership.
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the
Data Protection notice above
The Cooper Partnership - 26 Wren Avenue, Eastwood, Leigh on Sea, Essex, SS9 5AF
Email :
info@cooperinsurance.co.uk
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Registered with the DPA (Data Protection Act 1998) Registrar of Data Controllers Number Z8827130
Authorised and Regulated by the Financial Services Authority (FSA). Firm Number 300163
