Submit a request – Latitude Insurance

Your email address

First name

As it appears on identity documents

Surname

As it appears on identity documents

Relationship to the account

Your Full Name

Enter your full name that matches the information in our records

Date of birth

Tip: Click on the YEAR to select your birth year from the list

Mobile Number

Last 4 digits of your card or account number

Product(s) in this request?

Select the information you want to update

What information needs to be corrected?

Title

Updated name

You will be asked to supply a copy of your identity document. If you have changed your name by marriage, divorce or deed poll supply a copy of your marriage certificate, divorce order or deed. You will receive email instructions once you submit this request.

Amended date of birth

You will be asked to supply a copy of your identity document. You will receive email instructions once you submit this request.

I agree to be emailed a short customer feedback survey about the support received on this request(optional)

I consent to Latitude collecting my personal information, including any sensitive information disclosed in this Webform and I have read and agree to Latitude’s Privacy Policy. I agree to receive all communication relating to my request electronically.

Subject

Description

Attachments(optional)

Add file or drop files here