Your Personal Details

First name*

Surname*

Address*

Telephone number

Mobile phone number

Membership Number

Claim Details

Hospital Stay Benefit
To claim for a hospital stay, please upload a copy of your discharge letter.

Date (s) of hospital stay:

Date From*

Date To*

Reason for admission to hospital*

Copy of Hospital discharge letter

Payment Details

Payment will be made directly into the bank account we hold on record for you below. If the section is blank please provide details of the bank account you wish to receive payment.

Account number*

Sort code*

Claimant declaration and consent

I declare that I am not claiming for this claim under another health insurance product
I understand that any fraudulent claims may result in legal action being taken and immediate cancellation of my policy
I consent to ASFS processing any health and medical information contained in this form in order to pay my claim
I authorise any medical practitioner or other person(s) concerned with providing healthcare to give you any information relevant to this claim
I declare the information shown on this form and any accompanying documentation is true and complete

Digital signature: Please type your full name into this box

Privacy Notice

Anglo-Saxons Friendly Society Ltd acts as the data controller in respect of your personal data. We take your privacy seriously and we will receive, process and store data, including your personal data, to enable us to provide you with the services that we offer and for all other purposes consistent with the proper performance of our operations. For our full statement on data protection and privacy, click on ‘Privacy Policy’ at the bottom of the page.

Email verification

To complete your claims submission:

Press the green verification code button below
We will send a verification code to the email address used on this claim form
If the email address is incorrect or blank please contact our membership support team on 01474 567050 or email us at info@anglo-saxons.co.uk and we will update your membership contact details.
Copy and paste or key in the verification code from the email into the verification code box below and press submit.

Verify Code (required)

Complaints Policy

Complaints Procedure – Financial Services Regulated Insurance Contracts

Anglo-Saxons Friendly Society greatly values its members and aims to provide an excellent service at all times.

We are committed to treating our members fairly and use a friendly approach in all communications. However, we recognise that sometimes circumstances may arise where you feel you have cause for complaint.

We always do our best to resolve complaints as quickly, thoroughly and fairly as possible. This document explains how we respond to your complaint and what you can expect if you complain.

How to make a Complaint

In the first instance, please let us know what has happened by telling us:

Exactly what has gone wrong.
Your name address and contact phone number.
Your Membership Number if applicable.

You can contact us by:

Telephone:

If you would like to get in touch by telephone, please call 01474 567050

Email:

If you would like to get in touch by email you can send details of your complaint to info@anglo-saxons.co.uk

Post:

If you would like to make a complaint in writing, please send a letter to us at:

The Old Rectory,

Northfleet,

Gravesend, DA11 8HN

Our Complaints Handling Process

We aim to resolve complaints as quickly as possible and within 3 working days of receiving your complaint. If your complaint is resolved within 3 days, we will send you a Summary Resolution Communication that includes contact details for the Financial Ombudsman Service (FOS). If you are dissatisfied with our response, you can refer your complaint to the FOS within six months from the date of the Summary Resolution Communication.

However, some complaints are more complex and may require more time to investigate and resolve. If this is the case, we will write to you within 5 working days of receiving your complaint, summarising the complaint to ensure we have understood it correctly. We will also provide you with a paper copy of this document, ‘Making A Complaint’.

We will keep you updated throughout our investigation into your complaint and will write to you after 4 weeks if we are still investigating your complaint.

When we have completed our investigation, we will write to you within eight weeks and provide you with a Final Response, or a response that explains any further delay in investigating the complaint, and why we are unable to provide a final response at this stage.

If you are not satisfied with our response, you can refer your complaint to the Financial Ombudsman Service. You have six months to do this from the date of our Final Response or our response that explains further delay with the investigation. We will provide you with a FOS leaflet or link to the online version of the leaflet at this stage of the process.

The Financial Ombudsman Service (FOS)

The Financial Ombudsman Service is a free, independent service for resolving disputes between customers and financial services institutions.

Contact details:

Telephone: 0800 023 4567 or 0300 123 9123

Email: complaint.info@financial-ombudsman.org.uk

Website: www.financial-ombudsman.org.uk

Post:

The Financial Ombudsman Service,

Exchange Tower,

London,

E14 9SR