Thank you, your claim has been submitted. We are dealing with enquiries as quickly as possible and currently aim to respond to all queries within 12 weeks. Your patience is appreciated.

To assist us in assessing your claim, please provide the information below.

It may take up to 12 weeks to process the claim, so please bear with us.

Please provide information marked with an asterisk (*).

Name* :

Maiden name (if applicable) :

Date of birth (dd/mm/yyyy)* : / /

NI number* :

Current Address* :

Address in June 1999 :

Policy number :

Phone number* :

Tick here if you are requesting an update on your claim :

Have you already sent a claim form*?

If yes, what date did you submit it?