"*" indicates required fields Are you a wishing to modify or cancel a policy?* Modify Cancel To request a correction to a policy please request the appropriate change using form below. Where multiple changes are needed, please submit more than one request. To request a cancellation of a policy please provide a reason using form below.Selling Dealer*Dealer Contact Name*Dealer Email* Policy Number*Customer Surname*Reason for Modification*Modification Required*TitleForenameSurnameAddress / PostcodeTelephoneEmailVehicle Registration NumberVehicle VIN/Serial NumberVehicle MakeVehicle ModelVehicle Registration DateVehicle Purchase DateVehicle TransmissionVehicle MileageVehicle PriceStart DateDurationClaim LimitCover LevelPolicy Selling PriceOld Detail of Modified Field*New Detail of Modified Field*Reason for Cancellation*CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
