Date of birth validation

Date of birth error

If we've contacted you to verify your date of birth or another family member's, please complete the form below. You will find the information you need to complete the form in the communication we sent you.

Please enter the details here and add another member if required

First name(s) *

Last name *

Date of birth *

Add another member

First name(s) *

Last name *

Date of birth *

Add another member

First name(s) *

Last name *

Date of birth *

Add another member

First name(s) *

Last name *

Date of birth *

Add another member

First name(s) *

Last name *

Date of birth *

Please add details of any more members here

Please enter your bank account details

Based on what you've told us, your premium may have been incorrectly calculated due to us having an incorrect date of birth and this may have resulted in an overpayment of premium.

Please complete the details below so we can check and refund you if you're confirmed as affected.

If you have underpaid your premium due to the date of birth being incorrect you will not be required to repay anything.

Bank account name *

Bank account number *

Enter your personal details

These details help us verify who you are so we can deal with your enquiry as quickly as possible.

Title

Optional Optional Mr Mrs Miss Ms Mx None

First name *

Last name *

Date of birth *

Email *

Contact number *

Street name and number *

Suburb

Town / City *

Postcode

Country *

Policy number *

Are you the policyholder?

Yes

No

Where your application contains personal information about any other person you confirm you have obtained all necessary approvals to share that information with us.

Date of birth error

Please enter the details here and add another member if required

Please enter your bank account details

Enter your personal details

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