Register a Claim

Thank you for telling us you wish to register a claim. Please complete the information requested below so that we can start capturing the detail of the claim.

Please supply your details

Firstname *

Surname *

Email *

Please enter the phone number you want us to call you on *

Please supply the details of the person you are wishing to claim for

Firstname *

Surname *

Date of Birth*

Age:

Policy Number

Claim Details

Please briefly describe the nature of the claim, e.g. 'A relative/friend has passed away' or 'I wish to submit a claim for a terminal illness' *

Book a Time Slot

We will need to speak with you to progress the claim. Please select a time slot when we can call you. *

Friday 08 December	Between 8am and 1pm	Selected
Friday 08 December	Between 1pm and 6pm	Selected
Monday 11 December	Between 8am and 1pm	Selected
Monday 11 December	Between 1pm and 6pm	Selected
Tuesday 12 December	Between 8am and 1pm	Selected

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