Communicating with you in a way that suits your needs

Help us provide the service you need

When to complete this form

Only complete this form if you would like to make us aware of any temporary or permanent condition that may impact the way we communicate with you, or if you need an alternative format when we communicate with you.

For all other queries or to access our online service, please use the search bar under the 'Finding our contact details or access our online service' section here.

Your details

Title

Surname

House number or name

Previous Scheme or Insurer (if known)

Date of birth

Day

Month

Year

First name/Initial(s)

National Insurance number

Postcode

Policy number (if known)

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.

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