Withdrawal Histories form

Withdrawal histories request

You should only complete this form if:

you’re the policyholder, or the policyholder’s FCA registered financial adviser
the policy you’re requesting a withdrawal history for is a bond

You will need to complete the form one policy at a time. If this form is not suitable for your request, please get in touch.

We need the information requested in order to complete your request. You can find out more about how we use personal information by viewing our full privacy notice.

Policy number

Tell us about the policyholder

Policyholder full name

Policyholder daytime telephone number

Policyholder email address

Policyholder residential address

Policyholder Date of birth

Are you the policyholder’s FCA registered Financial Adviser?

Yes

Your name

Your company name

Your FCA reference number

Your email address

We can’t send you this information as you’re not a regulated financial adviser acting on the customer’s behalf. If you click submit below we will send the information you’ve requested to the policyholder directly and you will need to ask them to forward it on to you.

If you are human, leave this field blank.