Brandt ME250 Installation & Operating Instructions Manual page 24

SUMMARY OF EXTENDED WARRANTY PROTECTION
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Extended Insurance Application
INSURANCE DETAILS
PAYMENT METHOD
I enclose cheque/Post Order payable to Domestic & General Insurance PLC
Please charge my MasterCard / Visa / Delta / Switch account number
MasterCard / Visa / Delta / Switch expiry date
DECLARATION I hereby apply for the Domestic & General Insurance Plan in accordance with the terms and conditions of
your policy. I confirm that the equipment is in good working order and used for domestic purposes only and declare that the
details in this proposal are true and complete to the best of my knowledge and belief
Signature
WARNING: Any false statement may render your policy invalid
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I agree to pay the breakdown total insurance premium of (see table)
£ .
/
Date / /
&
UK ONLY
99626021 11/02