Stage 1 of 4

Personal Accident Plan
Application Form

Choose the plan that best fits your needs

You
Only £ 7.50 * per month

You and Your Children?
Only £ 9.50 * per month

You, Your Partner, and Your Children?
Only £ 14.55 * per month

You and Your Partner?
Only £ 12.50 * per month

You (and your partner if also enrolling) must be aged from 18 to 64 for cover to be authorised. Cover ceases at age 70.

Please confirm that you and all others to be insured are full-time UK residents ?

Please confirm that you have read the Exclusions and Limitations by
ticking the box. This will open up in a new window.

* All premiums are inclusive of Insurance Premium Tax at the current rate

Please contact customer services on 0800 023 2163

Benefits ranging from £100 per day to a lump sum payment of £250,000 for as little as £7.50 a month, that is just 25p per day.

Have a query?
Call the Accident
Help Line on
Telephone Freephone

Monday - Friday
8am - 8pm

Calls may be recorded
for training and
monitoring purposes