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Letter of authority form (valid for UK policies beginning with PR)

Step 1 of 3

Your details

Details marked with * must be completed in full.

Policy number(s) which you're giving your authority for (this MUST begin with PR):

First name:

Last name:

Contact number:

Email address:

Date of birth:

First line of your address:

Second line of your address (optional):

City or Town:

Postcode: