EKF Member Insurance – Insurance forms

Full Name of Association or Club*
Full Name of Licencing officer*
Email*
Phone*
Number of Members to be Insured*
Premium is £2.35 per member
Product Name
Enter First Name, Surname and Date of Birth of each member to be Insured*
Your premium is:
£ 0.00
Premiums include insurance premium tax at 12%
Date cover is required*
Date Format: DD slash MM slash YYYY
Activities are Karate only?*
(cover excludes the use of live/sharp blades)
- Yes
- No
Please phone us on 01603 626904 as this will need to be agreed in advance
Any previous claims?*
- Yes
- No
Please phone us on 01603 626904 as this will need to be agreed in advance
I confirm that the Association/Club and students are Current members of the EKF and that the information Provided is correct at the time of submission*
- I confirm
I have read, understood and agree to your terms & conditions*
- I agree
Read our Terms & Conditions
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Name
This field is for validation purposes and should be left unchanged.