Add a member to your company policy

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Please tick this box to confirm you are the group administrator

Your details

Please complete with the information we hold on file for you as the group administrator

If the email address you have provided isn’t the one we hold on our records we will get in touch with you by phone or post

The details of the member you would like to add

Please enter the date in the format dd/mm/yyyy

Please enter the date in the format dd/mm/yyyy

Is the person employed by the company?:

Dependents details

If you want to add other dependents please complete the following questions, otherwise you can simply submit the form

Dependent 1

Please enter the date in the format dd/mm/yyyy

Please only confirm their address if it is different to the employee's otherwise you can leave this blank.

Dependent 2

Please enter the date in the format dd/mm/yyyy

Please only confirm their address if it is different to the employee's otherwise you can leave this blank.

Dependent 3

Please enter the date in the format dd/mm/yyyy

Please only confirm their address if it is different to the employee's otherwise you can leave this blank.

Dependent 4

Please enter the date in the format dd/mm/yyyy

Please only confirm their address if it is different to the employee's otherwise you can leave this blank.

Do you have any additional support requirements you would like to make us aware of? Such as needing your documents in an alternative format or that you require additonal support with communicatios e.g. translator or being hard of hearing.

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