It is mandatory for the applicant to fill in at least one phone number.
We will email all policy documentation to the broker. By providing your customer’s email address above, we will also send documentation directly to your customer to save you time.
Third Party Declaration
Please note: This section is only to be completed if the person paying for the plan is not the policyholder.
I declare that I will pay the Direct Debit for the policy in the name of: and this level of financial commitment is affordable now and in the future.
Should a claim arise, I understand that I am not eligible to benefit in any way from the policy.
If you are the customer’s adviser you have your customer’s authority to accept the declaration below on their behalf.
I confirm i have read and accept the following
Please help us to go green
Each year we send policyholders an annual review letter and an Insurance Product Information Document, which is a summary of key information relating to your plan. As an environmentally responsible company, we would like to ask for your permission to send you this information by email - not only will this reduce the amount of paper we use, it will also make it easier for you to manage your policy paperwork.
Please can you tick the box below to confirm you are happy to receive this correspondence by email. Sincere thanks for your support in helping us to make a difference to the environment.
I request that my annual reviews and Insurance Product Information Documents are sent to me by email: