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  - Up to £100 in vouchers when you buy Life Insurance from Zurich - use 'ZOFFERS100' when you apply.
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    Protect the planet!
    Until 31 December 2019, we'll plant a tree for every Life or Travel insurance policy bought online.
  - Learn more about how
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  - Up to £100 in vouchers when you buy Life Insurance from Zurich - use 'ZOFFERS100' when you apply.
    Terms & conditions
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  - Up to £100 in vouchers when you buy Life Insurance from Zurich - use 'ZOFFERS100' when you apply.
    Terms & conditions
  - Get a quote
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- - Need Life Insurance?
  - Up to £100 in vouchers when you buy Life Insurance from Zurich - use 'ZOFFERS100' when you apply.
    Terms & conditions
  - Get a quote
Get a quote
- - Need Life Insurance?
  - Learn more about how
- - Investment
  - Stocks and Shares ISA
- - Insurance
  - Life insurance
  - Car Hire Excess Insurance
  - Travel insurance
  - Boat insurance

- - Need Life Insurance?
  - Up to £100 in vouchers when you buy Life Insurance from Zurich - use 'ZOFFERS100' when you apply.
    Terms & conditions
    
    Protect the planet!
    Until 31 December 2019, we'll plant a tree for every Life or Travel insurance policy bought online.
  - Learn more about how
- - Investment
  - Stocks and Shares ISA
- - Insurance
  - Life insurance
  - Car Hire Excess Insurance
  - Travel insurance
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Help & support
Existing customers

Critical illness, terminal illness and children’s critical illness claim form

Details marked with * must be completed in full.

Policy number:

Type of claim:

Critical illness

Terminal illness

Children’s critical illness

Your details

Title of the insured:

First name of the insured:

Last name of the insured:

Date of birth (dd/mm/yyyy):

dd/mm/yyyy

House name or number:

Address line 1:

Address line 2:

Town:

Postcode:

Preferred contact number:

Email address

Confirm email address

Preferred method of contact:

Cause of claim (diagnosis):

Date illness was confirmed:

dd/mm/yyyy

Child’s name (if applicable):

Child’s date of birth (if applicable):

dd/mm/yyyy

Relationship between you & the child (if applicable)

Details of your claim:

Critical illness, terminal illness and children’s critical illness claim form

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