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    Your Personal Details

    Claim Details

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

    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

    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:

    1. Press the green verification code button below

    2. We will send a verification code to the email address used on this claim form

    3. If the email address is incorrect or blank please contact our membership support team on 01474 567050 or email us at and we will update your membership contact details.

    4. Copy and paste or key in the verification code from the email into the verification code box below and press submit.

    Verify Code (required)

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    We use traffic log cookies to identify which pages are being used. This helps us analyse data about webpage traffic and improve our website in order to tailor it to customer needs. We only use this information for statistical analysis purposes and then the data is removed from the system.

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