There are only a few steps, it should take a few minutes to complete.
It’s important to know:
To understand more about how we process your personal information and the rights you have, please read our Privacy Statement.
These details need to match your policy documents
Please select address
Address:
##add1##
##add2##
##add3##
##add4##
##postcode##
Please check your details are correct before submitting the form.
First name: ##firstname##
Last name: ##lastname##
Date of birth: ##dateofbirth##
Address: ##address1## ##address2## ##address3## ##address4## ##postcode##
Mobile number: ##mobilephonenumber##
Email address: ##email##
Policy number: ##policynumber##
What is your claim in connection with: ##connection##
Date first absent from work due to disability or illness: ##datefirstabsent##
Leave a voicemail: ##voicemailpreference##