Advisers claim notification

Advisers details

Name of brokerage

Name of Financial Advisor

Email address (no mailboxes)

Phone number

Company details

Company making a claim

Point of contact

Position within the company

Phone number

Email address

Confirm Email address

Company Policy number (optional)

Employee details

Title

First name

Last name

Phone number

Email address

Confirm Email address

Date of birth

Address line 1

Address line 2 (optional)

Town/City (optional)

Postcode

Employees condition or symptoms

Date when symptoms first started

Has the employee been off with this condition before?

Is the employee currently or going to be absent from work?

If so, what date will/are they unable to work from? (optional)

If applicable, do they have an expected return to work date? (optional)

Employee’s salary at the point they went off sick

Date that the members salary will cease

What is the employees occupation?

Description of the employees day to day duties

What are the employees contracted hours

(if known) what are the employees GP details (optional)

Has the employee provided you with any medical information that we can get from you?

Are you happy with us to contact the absent employee?

Are you happy with our claims team to discuss the details of the policy with your employee?

Any other comments (optional)

Would you like to receive a decision outcome?

Please note, if the employee does not provide consent, we will be unable to go into the specifics surrounding their medical circumstances

Make a claim online for financial advisers

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Advisers details

Company details

Employee details

Make a claim online for financial advisers

Get your claim started

Advisers details

Company details

Employee details

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