Protection Enquiry Form

The internet is not a secure medium and the privacy of your data cannot be guaranteed.

Thank you for your enquiry, someone will contact you shortly.

Title

Forename(s)

Surname

Telephone

Mobile

Email Address

Best Time to Call

Your Address

House Name / No.

Street

Town

County

Postcode

Cover Required

Life Cover Product

Term of Cover (years)

Family Income Benefit

Renewable

Amount of Cover

Cover Basis

Premium Type

Premium Frequency

Lives Assured

Cover Type

1st Life Assured

Date of Birth (DD/MM/YYYY)

Sex

2nd Life Assured

Date of Birth (DD/MM/YYYY)

Sex

Submit Your Information

How did you hear about us

Your Privacy

We take your privacy seriously. Personal data submitted to The Midas Mortgage Centre with this form will be treated in accordance with the Data Protection Act 2018. By submitting this enquiry form you expressly consent to be contacted in relation to your enquiry, without prior notice or arrangement, using the contact details provided on the form.

Main Office

The Midas Mortgage Centre,
64 New Road
Shoreham-by-Sea
BN43 6RB
Telephone. 0345 539 0198
Email. adminmidasmortgagecentre.co.uk
Stuart Bryan Avern trading as The Midas Mortgage Centre is an Appointed Representative of PRIMIS Mortgage Network, a trading name of Advance Mortgage Funding Limited which is authorised and regulated by the Financial Conduct Authority for mortgages, protection insurance and general insurance products.

Copyright © 2024 The Midas Mortgage Centre