Use this form to get help with to complete your claim.
This form should take no longer than 10 minutes to complete.
To complete this form you will need:
- your name
- your email
- your phone number
- your address, if you request a home visit
This form expires after 20 minutes of inactivity.
We are a data controller for the purposes of data protection legislation.
We hold and process all personal information in line with data protection legislation.