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Membership application

    Personal information

    Premium and payments

    Total Premium:

    Enter your nominated bank details for claim payments to be paid. Please note these should be the same as those provided for your Direct Debit membership fees

    Identity checks

    We are required to verify your identity when you become a Member of the Society.

    Please upload two separate forms of identification for your name and address. For example, if you provide your driving licence as proof of your name you must provide another form of identification for your address, such as a utility bill.

    Cover details

    Please read the declarations and confirm your consent

    Key facts
    Sickness Plan Product Brochure
    Sickness Plan application B/W print friendly form
    About us

    Email verification

    To complete your membership application:

    1. Press the green verification code button below

    2. We will send a verification code to the email address you have input on this application

    3. Copy and paste or key in the verification code from the email into the box below. Once you have entered the code, press the proceed to direct debit set up button at the bottom of the page.

    Verify Code (required)

    Once this form is submitted you will be redirected to a page containing our bank details for payment.

    Completing this form will not result in you receiving additional marketing information from us.