Income Protection Claim Notification

If you need to make a claim, the first step is to notify us by completing the form below.

All details you submit are treated with strictest confidence and stored securely.

Plan number*

Title*

First name*

Surname*

Date of birth*

Preferred contact number*

Preferred contact time*

Email address*

Confirm email address*

House name or number*

Address line 1*

Address line 2

Town/City*

Region

Postcode*

The date you last worked*

Details of your claim*