• Maintenance Application Form

  •  Customer Details:                                                                                                                                    

  •  Boiler Details:                                                                                                                                          

  • If you wish to select extra gas appliances, please list below which appliances you would like covered (i.e cooker, fire etc)

  •  Method of Payment:                                                                                                                               

  • Direct Debit Form

    Instruction to your bank or building society to pay by Direct Debit

  • Originators Identification Number

         8 0 6 4 3 3

  • To: The Manager

  • Instruction to your Bank or Building Society

    Please pay London & Zurich plc. Direct Debits from the account detailed in this instruction subject to safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with London & Zurich plc and it fo, details will be passed electronically to my bank / building society.

  • Terms & Conditions

  •  Declaration:                                                                                                                                    

  • I hereby apply for the above cover and agree to the terms and conditions. I can confirm that, to the best of my knowledge, the information I have supplied is correct and the appliance listed is in good working order.

  • The Direct Debit Guatantee

    This guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.

    If there are any changes to the amount, date or frequency of your Direct Debit, London & Zurich plc will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request London & Zurich to collect a payment, confirmation of the amount and date will be given to you at the time of the request.

    If an error is made in the payment of your Direct Debit, by London & Zurich or your bank or building society you are entitled to a full and immediate refund of the amount paid from your bank or building society. If you receive a refund you are not entitled to, you must pay it back when London & Zurich asks you to.

    You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.

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