Submit your change to your Direct Debit Auto Renewal

If you currently pay by Direct Debit and you wish to opt in or out of having your policy automatically renew via an instalment arrangement, please complete the below form

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Client reference number: 15/ *

Policy Holders Full Name: *

Full correspondence address: *

Opting out of automatic renewal means you must contact us each year to renew your policy, if you are unable to contact us for any reason it may result in you being uninsured. Are you happy for your policy to automatically renew? *

Yes*
No

Consent for storing submitted data *

Yes, I give permission to store and process my data
No, I don't consent to storing and processing my data