Statement of account/benefits

This form allows you to request a statement of account or statement of benefits.

Please fill in the following form so that we may respond to your request.

Requested document

Client No.

Title

Name *

First name *

Date of birth *

Postcode and town *

Telephone *

Email address *

Does the request apply to other family members?

Message

Travel insurance

Insurance when travelling abroad

Event LeClub

Family discovery on Saturday 14 September 2019

Household contents

Compensation in the event of damage or theft

GMapp

Your health insurance data on your smartphone