Membership Declaration

"*" indicates required fields

Please complete the below form to submit your request.

Declaration Choice*

Please upload all relevant attachments.

Max. file size: 32 MB.

The above declaration is required to confirm that eligibility requirements for Dependant cover continue to be met. If your membership is paid via direct debit and a dependant extension option is selected, the direct debit amount will be updated as required to include this additional amount.

This field is for validation purposes and should be left unchanged.