apply.enableinsurance.co.uk Open in urlscan Pro
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Form analysis
2 forms found in the DOM

POST

<form method="POST" class="top-space">
  <center><input type="submit" name="existing-N" class="width-fixed" value="No"> <input type="submit" name="existing-Y" class="width-fixed" value="Yes"></center>
</form>

POST

<form method="POST" novalidate="" id="application">
  <div class="row form-section">
    <div class="col-md-12">
      <h2>Your Details</h2>
    </div>
  </div>
  <div class="row form-section">
    <div class="col-md-3">
      <label class="form-label">Full name <span class="required">*</span></label>
    </div>
    <div class="col-md-9">
      <select name="title" required="" data-sel="notfound" placeholder="Title">
        <option></option>
        <option>Mr</option>
        <option>Miss</option>
        <option>Mrs</option>
        <option>Ms</option>
        <option>Dr</option>
      </select>
      <input type="text" name="forename" required="" placeholder="Forename(s)">
      <input type="text" name="surname" required="" placeholder="Surname">
    </div>
  </div>
  <div class="row form-section">
    <div class="col-md-3">
      <label class="form-label">Address <span class="required">*</span></label>
    </div>
    <div class="col-md-9 address">
      <input type="text" name="address-line1" class="display-none" required="" placeholder="Address 1" style="display: none;">
      <input type="text" name="address-line2" class="display-none" placeholder="Address 2" style="display: none;">
      <input type="text" name="address-line3" class="display-none" placeholder="Address 3" style="display: none;">
      <input type="text" name="address-town" class="display-none" required="" placeholder="Town" style="display: none;">
      <select id="address-select" class="display-none"></select>
      <input type="text" name="address-postcode" required="" placeholder="Postcode" class="display-none" style="display: none;"> <span class="lookup">Lookup</span>
    </div>
  </div>
  <div class="row form-section">
    <div class="col-md-3">
      <label class="form-label">Email address <span class="required">*</span></label>
    </div>
    <div class="col-md-9">
      <input type="text" name="email" required="" placeholder="Email address" valid="false">
    </div>
  </div>
  <div class="row form-section">
    <div class="col-md-3">
      <label class="form-label">Contact number <span class="required">*</span></label>
    </div>
    <div class="col-md-9">
      <input type="text" name="telephone" required="" placeholder="Telephone No">
    </div>
  </div>
  <div class="row form-section">
    <div class="col-md-3">
      <label class="form-label">Date of birth <span class="required">*</span></label>
    </div>
    <div class="col-md-9">
      <input type="date" required="" name="DoB" id="dateOfBirth">
    </div>
  </div>
  <div class="row form-section">
    <div class="col-md-3">
      <label class="form-label">When would you like your cover to start? <span class="required">*</span></label>
    </div>
    <div class="col-md-9">
      <input type="date" required="" name="policy-start" id="policyStartDate">
      <p style="font-size: .9em;">Policy cannot start in the past or<br>more than 90 days in the future</p>
    </div>
  </div>
  <div class="row form-section">
    <div class="col-md-3">
      <label class="form-label">Correspondence Address (if different)</label>
    </div>
    <div class="col-md-9 address">
      <input type="text" name="corr-address-line1" class="display-none" placeholder="Address 1" style="display: none;">
      <input type="text" name="corr-address-line2" class="display-none" placeholder="Address 2" style="display: none;">
      <input type="text" name="corr-address-line3" class="display-none" placeholder="Address 3" style="display: none;">
      <input type="text" name="corr-address-town" class="display-none" placeholder="Town" style="display: none;">
      <select id="corr-address-select" class="display-none"></select>
      <input type="text" name="corr-address-postcode" placeholder="Postcode" class="display-none" style="display: none;"> <span class="corr-lookup">Lookup</span>
    </div>
  </div>
  <div class="row form-section">
    <div class="col-md-3">
      <label class="form-label light">Where did you<br>hear about Enable Insurance? <span class="required">*</span></label>
    </div>
    <div class="col-md-9">
      <select name="hear-about" required="" data-sel="notfound">
        <option></option>
        <option>Friend/Family</option>
        <option>Nanny</option>
        <option>Previous Client</option>
        <option>Search Engine</option>
        <option>Agency</option>
        <option>Another Website</option>
        <option>Nannytax</option>
      </select> <input type="text" name="hear-about-other" required="" placeholder="Please specify ..." style="display: none;">
    </div>
  </div>
  <!-- Do not show for renewal -->
  <div class="row form-section">
    <div class="col-md-3">
      <label class="form-label">Are you a Nannytax customer? *</label>
    </div>
    <div class="col-md-9">
      <label class="nt-radio"> Yes <input type="radio" name="nt-customer" required="" value="YES">
        <span class="selection-box"></span>
      </label>
      <label class="nt-radio"> No <input type="radio" name="nt-customer" required="" value="NO">
        <span class="selection-box"></span>
      </label>
      <div class="customer-no" style="display: none;">
        <input type="text" name="nt-customer-no" placeholder="Customer Number" required="">
      </div>
    </div>
  </div>
  <div class="row form-section">
    <div class="col-md-12">
      <h2>Declarations</h2>
    </div>
  </div>
  <div class="row form-section">
    <div class="col-md-9">
      <p>No insurer has ever declined my proposal, refused my renewal or terminated my cover for any reason or imposed special terms</p>
    </div>
    <div class="col-md-3">
      <label class="nt-radio"> True <input type="radio" name="dec-1" required="" value="YES">
        <span class="selection-box"></span>
      </label>
      <label class="nt-radio"> False <input type="radio" name="dec-1" required="" value="NO">
        <span class="selection-box"></span>
      </label>
    </div>
  </div>
  <div class="row form-section-sm">
    <div class="col-md-9">
      <p>I, nor anor any other person named on the policy, have never been convicted, but not yet tried, with a criminal offence other than a motoring offence or have any conviction whcih is spent</p>
    </div>
    <div class="col-md-3">
      <label class="nt-radio"> True <input type="radio" name="dec-2" required="" value="YES">
        <span class="selection-box"></span>
      </label>
      <label class="nt-radio"> False <input type="radio" name="dec-2" required="" value="NO">
        <span class="selection-box"></span>
      </label>
    </div>
  </div>
  <div class="row form-section-sm">
    <div class="col-md-9">
      <p>I, nor anor any other person named on the policy, have not made a claim under a liability policy in the last 5 years</p>
    </div>
    <div class="col-md-3">
      <label class="nt-radio"> True <input type="radio" name="dec-3" required="" value="YES">
        <span class="selection-box"></span>
      </label>
      <label class="nt-radio"> False <input type="radio" name="dec-3" required="" value="NO">
        <span class="selection-box"></span>
      </label>
    </div>
  </div>
  <div class="row form-section-sm">
    <div class="col-md-9">
      <p>I confirm that the home that will be the nanny's predominant place of work is in good state of repair and so mantained at all times</p>
    </div>
    <div class="col-md-3">
      <label class="nt-radio"> True <input type="radio" name="dec-4" required="" value="YES">
        <span class="selection-box"></span>
      </label>
      <label class="nt-radio"> False <input type="radio" name="dec-4" required="" value="NO">
        <span class="selection-box"></span>
      </label>
    </div>
  </div>
  <div class="row form-section checkbox">
    <div class="col-md-12">
      <label class="nt-checkbox">
        <input type="checkbox" name="terms-of-business" required="" value="I agree" id="i-agree">
        <span class="selection-box"></span>
      </label> <label for="i-agree">I confirm that I have read and understand the <a href="//192.168.36.37:8084/wp-content/uploads/2020/06/NE_TOB_220520.pdf" target="_blank">Enable Insurance Terms of Business</a>,
        <a href="//192.168.36.37:8084/wp-content/uploads/2020/06/ELI_POLSUM_220520.pdf" target="_blank">Policy Documentation</a> and <a href="//192.168.36.37:8084/privacy-policy/" target="_blank">Enable Ltd’s Privacy Policy</a></label>
    </div>
  </div>
  <div class="row form-section checkbox">
    <div class="col-md-12">
      <label class="nt-checkbox">
        <input type="checkbox" name="post-policy" value="YES" id="post-policy">
        <span class="selection-box"></span>
      </label> <label for="post-policy">Enable Insurance is proud to be an environmentally friendly business, we send our policy documents electronically (you will receive these on email shortly). However, if you’d still like to receive a copy of
        your documents in the post, please indicate this by clicking the tick box.</label>
    </div>
  </div>
  <div class="row form-section terms">
    <div class="col-md-12 text-center">
      <a class="document nowrap" href="//new.Enable Insurance.co.uk/wp-content/uploads/2019/10/IPID_NI_22082018.pdf" target="_blank">Insurance Product Information Document</a>
    </div>
  </div>
  <div class="row toolbar">
    <div class="col-md-12">
      <a href="/default" class="form-button">Clear form</a> <a href="javascript:window.print()" class="form-button" id="print">Print form</a>
      <input type="submit" name="submit" value="Continue &amp; Pay" class="pull-right">
      <p class="space-top" style="margin-bottom: 0;"><b>Please note:</b> Cover will not commence until you have received formal confirmation from Enable Insurance</p>
    </div>
  </div>
</form>

Text Content

PLEASE ENABLE JAVASCRIPT TO CONTINUE.


POLICY APPLICATION

Do you have a policy with us already that is due for renewal?




POLICY APPLICATION FORM

Based on the information obtained from you we have identified that your demands
and needs are those of a person who wishes to employ a Nanny.

You are required by the provisions of the Consumer Insurance (Disclosure and
Representations) Act 2012 to take care to supply accurate and complete answers
to all the questions in the declaration and to make sure all information
supplied is true and correct. You must tell us of any changes to the answers you
have given as soon as possible. Failure to advise us of a change in your answers
may mean that your policy is invalid and that is does not operate in the event
of a claim.

One or more missing fields
We could not find an address associated with the postcode you provided.
There was an error connecting to the postcode lookup server. Please try again.
You must be 16 or older to use this service.
Your policy cannot start in any more than 90 days from now.
The given email address is invalid.
The given phone number is invalid.
The given payroll number is invalid.
Your policy cannot start more than 90 days in the future.
Your policy cannot start in the past.


YOUR DETAILS

Full name *
Mr Miss Mrs Ms Dr
Address *
Lookup
Email address *

Contact number *

Date of birth *

When would you like your cover to start? *

Policy cannot start in the past or
more than 90 days in the future

Correspondence Address (if different)
Lookup
Where did you
hear about Enable Insurance? *
Friend/Family Nanny Previous Client Search Engine Agency Another Website
Nannytax
Are you a Nannytax customer? *
Yes No



DECLARATIONS

No insurer has ever declined my proposal, refused my renewal or terminated my
cover for any reason or imposed special terms

True False

I, nor anor any other person named on the policy, have never been convicted, but
not yet tried, with a criminal offence other than a motoring offence or have any
conviction whcih is spent

True False

I, nor anor any other person named on the policy, have not made a claim under a
liability policy in the last 5 years

True False

I confirm that the home that will be the nanny's predominant place of work is in
good state of repair and so mantained at all times

True False
I confirm that I have read and understand the Enable Insurance Terms of
Business, Policy Documentation and Enable Ltd’s Privacy Policy
Enable Insurance is proud to be an environmentally friendly business, we send
our policy documents electronically (you will receive these on email shortly).
However, if you’d still like to receive a copy of your documents in the post,
please indicate this by clicking the tick box.
Insurance Product Information Document
Clear form Print form

Please note: Cover will not commence until you have received formal confirmation
from Enable Insurance

Enable Insurance Services is the trading name of Enable Limited, registered in
England and Wales, No. 04552449, registered office Victoria House, 125 Queens
Road, Brighton, East Sussex, BN1 3WB. Enable Limited is an Appointed
Representative of Fish Administration Limited, who are authorised and regulated
by the Financial Conduct Authority. Firm Reference Number is 310172. Fish
Administration Limited is registered in England and Wales. Company Registration
Number 4214119. Registered Office: Rossington’s Business Park, West Carr Road,
Retford, Nottinghamshire, DN22 7SW.
October, 2020

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October, 2020

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