Title:
Mr
Mrs
Miss
Ms
Full Name:
*
Date of Birth:
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Marital Status:
Single
Married
Partnered
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Separated
Widowed
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Sex:
Female
Male
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Home Address:
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*
Home Telephone:
at least one required
Mobile Telephone:
E-mail:
*
Employer:
Exact Occupation:
Union:
*
Workplace Name and Address:
*
*Denotes required fields
I am interested in hearing about my Union/Employer's Salary Protection Scheme and would like an information pack sent to me
I would be interested in getting an insurance quote around my renewal date:
Car Insurance Renewal Date (best guess)
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2010
2011
Home Insurance Renewal Date (best guess)
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2010
2011
DATA PROTECTION
I hereby consent to the use and recording of my personal details (contained herein or provided subsequently) by Cornmarket. I understand that the details I have provided will be held on computer, and/or in printed form or otherwise by Cornmarket. I agree that this information may be used in the future to contact me (by mail/e-mail or telephone) about Cornmarket services which may be of interest to me.
I understand that the information provided by me will not be passed on to third parties for the purposes of direct marketing.
I also understand that I may at any stage, at no cost, instruct Cornmarket in writing to no longer hold my data for the purpose of sending me such information and that I have a right of access to and the right to rectify the data concerning me held by Cornmarket.
If you do not want to avail of your Free Accidental Death Benefit, please tick here
If you do not want to receive information about other preferential deals available to union members, please tick here
Entry conditions:
No purchase necessary. Deadline for entries: October 31st 2010. Subject to union membership. Winner's photo may be used for publicity.
Cornmarket Group Financial Services Ltd. is regulated by the Financial Regulator. Telephone calls may be recorded for quality control purposes. A member of the Irish Life & Permanent Group. Irish Life & Permanent plc is regulated by the Financial Regulator.