Stationery Order Form

To order stationery from Groupama please complete the form below.

Please quote your agency code on all correspondence and messages.

All mandatory fields are marked with an asterisk*


Agent Name:*
Agency Code:*
Postcode:*
Contact Name:*
Contact Number:*
Email Address:*

Healthcare		Qty
Healthcare Sample Document Pack	GR041
Policy Summary Club	GR412
Policy Summary Carte Blanche	GR413
Policy Summary Classic	GR414
Member Application Form	GR415
Company Application Form	GR416
Your Subscription Tables	GR417
Your Policy Guide	GR418
Information, Advice & Counseling Services	GR419
Your Benefits Table	GR420
Your Gold & Silver Benefits Table	GR421
Healthcare For Individuals	GR422
Healthcare For Companies	GR423
Helpline Card	GR432
Changes Update for 2006 - Individuals (Carte Blanche, Classic or Club)	GR425
Changes Update for 2006 - Group = Secretaries	GR426
Changes Update for 2006 - Gold & Silver members	GR429
Changes Update for 2006 - Intermediaries	GR430

Home		Qty
Bedrooms Proposal & Prospectus	GR212
Bedrooms Policy Booklet	GR216
Home Proposal & Prospectus	GR211
Home Policy Booklet	GR215
Home Claim Form	GR164

Motor		Qty
Additional Drivers Form	GR084
Optima Private Motor Policy Booklet	GR040
Optima Van Policy Booklet	GR240
Optima Private Motor Proposal	GR039
Optima Plus Proposal	GR526
Optima Bike Proposal	GR292
Optima Bike Policy Booklet	G242
Optima Van Proposal	GR290
Optima Van Technical Guide	G560
Administration EDI products procedures booklet	G546

Fleet		Qty
Proposal	GR252
Accident Claim Form	GR071
Theft Claim Form	GR070

Commercial		Qty
Optima Business Proposal	GR653
Golf Secure Proposal	GR144
Premier Flats Declaration Proposal	GR407
Property Owners Proposal	GR148
Tradesman Select Proposal	GR119
Property and Loss Damage Claim Form	GR085
Public/Employers Liability Claim Form	GR054

Miscellaneous		Qty
Creditplan Application Form (Not applicable to motor products or Tradesman)	GR567
Lost Certificate Declaration	GR253
Master Card/Visa Form	GR083
Statutory Declaration	GR072

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We will use this information only to respond to your enquiry and for no other purpose. The internet is not a secure system and your privacy cannot be guaranteed. If you are in any doubt do not input any data.