Customer Request Form How can we help you today? Title * Select Mr Mrs Miss Ms Dr Rev First Name(s) * Surname * Date of Birth * Telephone Number * Email Address * Certificate Number * What type of policy do you have?* Select Rent Protection Tenants Contents Tenants Liability Are you a landlord or letting agent?* Landlord Letting Agent Please enter your company name* How do you pay for the policy?* Select Direct Debit Debit Card Credit Card What would you like to do today?* Select Change the rent amount Amend the insured address Cancel my policy Change my bank details Change my correspondence address Change my e-mail address Change my phone number Get a copy of my insurance documents Do you have more than one policy that you wish to cancel?* Yes No Please upload your documents containing the relevant policy numbers and insured addresses for the policies you wish to cancel * Do you wish to cancel from renewal?* Yes No Please specify what date you would like your policy cancelled from * What is the reason you wish to cancel today?* Select Cancelling at renewal Cancelling during cooling off period New Paymentshield application Cover no longer suitable Property sold Cheaper quote Tenancy Ended/Property Vacant Cheaper quote with competitor Competitor product terms more suitable Product no longer required What method would you like to receive confirmation this request has been completed?* E-mail Post Address Line 1 * Address Line 2 Town * County * Postcode * Please confirm the following statements* I have an insurable interest in the property The property will only be used for residential purposes by the tenant(s) The property will only be let to tenants aged 18 or over An acceptable tenancy agreement will be in place for the duration of this policy The required credit and ID checks have been carried out on the tenant(s) or guarantor The first month's rent has been paid, or will be paid before allowing the tenant(s) into possession of the property All statutory pre-grant notices have been issued, or will be issued before allowing the tenant into possession of the property I Confirm Do you want to make these changes to all the policies you have with us?* Yes No What method would you like to receive confirmation this request has been completed?* E-mail Post What is your new e-mail address? * Do you want to make these changes to all the policies you have with us?* Yes No What method would you like to receive confirmation this request has been completed?* E-mail Post What is your new phone number? * Do you want to make these changes to all the policies you have with us?* Yes No What method would you like to receive confirmation this request has been completed?* E-mail Post Do you require insurance documents for any other policies?* Yes No Please upload your documents containing the relevant policy numbers and insured addresses for which you wish to receive copies of your insurance documents * How would you like to receive your insurance documents?* E-mail Post New Sort Code * New Account Number * Account Name * Do you want to make these changes to all the policies you have with us?* Yes No What method would you like to receive confirmation this request has been completed?* E-mail Post What would you like to change the rent amount to? * What method would you like to receive confirmation this request has been completed?* E-mail Post Address Line 1 * Address Line 2 Town * County * Postcode * Please confirm the following statements* I have an insurable interest in the property The property will only be used for residential purposes by the tenant(s) The property will only be let to tenants aged 18 or over An acceptable tenancy agreement will be in place for the duration of this policy The required credit and ID checks have been carried out on the tenant(s) or guarantor The first month's rent has been paid, or will be paid before allowing the tenant(s) into possession of the property All statutory pre-grant notices have been issued, or will be issued before allowing the tenant into possession of the property I Confirm What method would you like to receive confirmation this request has been completed?* E-mail Post Please enter the characters shown below * Submit