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)

Terms and Conditions

Welcome to the Anglo-Saxons Friendly Society Limited website.

Regulation

Anglo-Saxons Friendly Society Limited is an incorporated Friendly Society (Registration No. 189F) and is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and Prudential Regulation Authority (No 139421). You can check these details on the FCA Register at www.fca.org.uk or by contacting the FCA on 0800 111 6768.

Registered office: The Old Rectory, Springhead Road, Northfleet, Kent, DA11 8HN.

Legal Information

The following terms and conditions are applicable to your use of our website and your relationship with the Society. Please read them carefully as your continued use of the website implies that you accept these. If you do not accept the terms and conditions, please refrain from using the website.

Variations

These Terms and Conditions may be updated from time to time and will be posted on this website. Your continued use of the website after any updates have been posted, implies your agreement to be bound by the new Terms and Conditions.

UK Legislation

The pages on this website comply with the appropriate UK legislation and regulation. Any dispute arising from the use of this website will be resolved under the law and courts of England and Wales. No liability is accepted if this website is accessed from outside the UK where its contents are illegal or unlawful.

Accuracy of Information

Whilst every precaution has been taken to ensure the accuracy of the information provided, no liability will be accepted for errors or omissions.

Availability

The website is normally available 24 hours a day but we cannot accept responsibility arising from any loss or damage arising from the website being unavailable.

No guarantee is made that this website is free from viruses, defects or changes by unauthorised third parties and as such we cannot be held responsible for any loss or damage pertaining to this. Similarly, we will not be liable for any incompatibility of the website with any of your equipment or software, or the failure of the website to meet your requirements.

Copyright

Copyright of this website belongs to Anglo-Saxons Friendly Society Limited and may not be used, sold, licensed, copied or reproduced in whole or part or in any matter or in or on any media by any person without the prior written consent of the Society.

Material from the website can be downloaded for personal use only. No rights are transferred to you by downloading material.

Privacy Policy

You can access our Privacy Policy here.

Cookie Policy

You can access our Cookie Policy here.

Links to External Websites

Links to third-party websites are provided for your convenience only and where we think these may be of benefit to you. This is not an endorsement and we have no responsibility for the content of that website. By clicking on these, you will be subject to the Terms and Conditions of those websites.

Please note that telephone calls may be recorded and monitored for training purposes.