Buildings Insurance - Long Term Lending Date of Issue: November 2016 | Version: 1
1. Insurance Company Details
2. Policy Details
Policy Number: Renewal date:
Amount of cover (£): Agreement No.
I authorise Masthaven Bank Ltd to note their interest on my Buildings Insurance Policy.
Applicant 1 Applicant 2
Print Name: Print Name:
The “Masthaven” name and logos and all other brands, names, logos, marks and slogans on this document are the trademarks or service
marks of us or our licensor’s.
Masthaven Bank Limited is a company registered in England & Wales with registration number 09660012 and whose registered office is
at: 4th Floor, 11 Soho Street, London W1D 3AD. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct
Authority and the Prudential Regulation Authority (Firm reference number 719354).
Tel: 020 7036 2020 Email: firstname.lastname@example.org Website: www.masthaven.co.uk
*All calls are monitored for quality and training purposes.