Step 1 of 4
This should take less than 3 minutes to complete.
Before you start, check if this form is right for you. Select the option that best describes you:
In that case, we recommend you taking a look at our personal health care plans!
In that case, we recommend you taking a look at our dedicated page for intermediaries here.
Great - please contact us and we'll be happy to discuss your policy with you.
Fill in all fields unless marked as optional
Enter the registered company name as it appears on official documents.
Enter the registered company postcode as it appears on official documents.
Enter the total number of employees. If unsure, please provide an approximate number.
Enter the name of the company who your cover is with
Please complete all required fields in order to proceed
By submitting this form, I confirm I am happy to be contacted to discuss how Simplyhealth can help my business, as well as receiving future information and offers, using the information I have provided.
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