Communicating with you in a way that suits your needs

Help us provide the service you need

When to complete this form

Complete this form if you would like us to use one of the formats below when communicating with you or make us aware of any temporary or permanent condition that may impact the way we communicate with you.

Your details

Title

Surname

Date of birth

Day

Month

Year

Previous Scheme or Insurer (if known)

Policy number (if known)

First name/Initial(s)

National Insurance number

Your contact information

Your telephone number

Your email address

Your data

Please provide your consent for storing and processing the data you have provided on this form.

Yes, I give permission to store and process my data

How Rothesay uses your data

For information on how Rothesay uses your data, please click on the link below.

Privacy notice for policyholders