SUB AQUA & MARINE INSURANCE SERVICES LTD WESTFIELD INSURANCE Clasford Lodge, Clasford Farm, Aldershot Road, Guildford, Surrey GU3 3HQ Call from UK 01483 237827 or fax 01483 234856 Call from abroad +44 1483 237827 or fax +44 1483 234856 Terms of business Authorised & Regulated by the Financial Services Authority. Westfield Sub Aqua & Marine Insurance Services Ltd is registered as a limited company in England No. 450587. Registered Office: Clasford Lodge, Clasford Farm, Aldershot Road, Guildford, Surrey GU3 3HQ

COMPRESSOR INSURANCE ENQUIRY FORM Policyholder Address 1 Address 2 Town County Postcode Email Address Telephone Cover to commence from Cover required Option 1   Option 2   Air Compressor and/or Air Receiver Make Model Serial number Sum insured £ Location of receiver if different from above (if option 2 selected) How did you first hear of our services? (Website, friend, advert, search engine, etc.) We recommend that you print and keep a copy of the enquiry form for your own records.