Quick and simple on-line application...

Use this form if you are an individual with no business income
Notes:
Cover is for an individual only. If you are a couple then to cover you both requires two separate applications

If you have business income this application form is not appropriate. Please complete business application

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required fields are shown in RED

Please select the approximate annual income band for you as an individual	Less than £100,000 £100,001-£500,000 £500,001-£2,500,000 £2,500,001-£5,000,000
Annual Tax Defence premium:
TOTAL
Name:
Email:
Address:
City:
Country:
Postcode:
Phone Number:
	I am not aware of any current or impending investigation or dispute with the Revenue Authorities. I accept the Policy terms and conditions and understand that the insurance documentation will be posted to me shortly and that the insurance will commence from the date the returned documentation and payment are received.

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