Dated
Once you and your vet have completed the form, the quickest way to get it to us is simply email it to the address above
with the supporting documents. Alternatively you can send it by post to: M&S Pet Insurance, Freepost – RSKZ-LTHJ-TZEG,
POBox 1361, Peterborough PE2 2QX. Our Claims Helpline is 0800 980 8750.
C ABOUT YOUR PET’S CONDITION
D YOUR PREVIOUS VETERINARY PRACTICES
(Please tell us all vet(s) where your pet was previously registered)
E YOUR DECLARATION, WHO TO PAY AND DATA PROTECTION NOTICE (Please complete boxes a & b below to tell us
who to pay)
CONDITION 1 CONDITION 2
Please tell us when you noticed your pet was unwell
or injured. If your pet has had the same or similar changes
in health we require the first date.
A description of the changes to your pet’s health that you noted.
Did you contact our 24 hour vetfone service for advice
on your pet’s condition before seeing your vet?
Please call 0800 9805583 if required in the future.
Was your pet under your care at the time of the illness/
injury/incident?
If no, please provide the name and address of any authorised
third party looking after your pet at the time of the incident
If your pets claim is for an injury, do you believe that another person was at fault? If so, please provide details separately Yes
No
PET INSURANCE
CLAIM FORM
mandspet.claims@uk.rsagroup.com
I declare, to the best of my knowledge and belief, that all the information provided in this form is true and complete. I agree that M&S Pet
Insurance may seek any information it requires from any vet. I accept that the information provided may be released to other companies
who provide a service to M&S Pet Insurance in connection with managing and handling claims. Please ensure you provide us with your
mobile number and email address so that we can keep you informed of the progress of your claim.
a YOUR DECLARATION. By ticking the following box, I confirm that I agree with the above statement:
My name is
I am the Policyholder:
I am the Joint policyholder:
c PAYMENT METHOD: If you pay your premium by Direct Debit we will automatically pay any settlement into that account by electronic
transfer. If Direct Debit is not used please ensure that you provide us with your contact details in Section A above, in the event we have to
contact you to agree an alternative payment method.
b WHO WOULD YOU LIKE US TO PAY: Policyholder:
Joint policyholder:
Vet Practice/Organisation:
Please note: if we decide we cannot pay some or all of your claim, it is your responsibility to pay your vet.
IF ANY REQUIRED INFORMATION IS NOT RECEIVED THEN THERE WILL BE A DELAY TO YOUR CLAIM.
Vet name
Address
Postcode
Phone number
Date: from to
Vet name
Address
Postcode
Phone number
Date: from to
Please tell us your address at that time, if
it was different to the address in Section A.
Postcode
CONTACT DETAILS
Daytime tel
Mobile tel
Email
Breed
Your pet’s microchip number:
How long have you owned your pet?
A ABOUT YOU (THE POLICYHOLDER)
NAME, ADDRESS AND POSTCODE
If your name or address has changed,
please tick
(Please note that changes to your
address may affect your premium)
B ABOUT YOUR PET
Your pet’s name
Cat Dog Male Female
Pet’s date of birth
POLICY
NUMBER
Time and date Time and date
Date Date
IMPORTANT INFORMATION-PLEASE READ
Is this claim for a:
New Condition
Please complete all sections
Continuation Condition
Please complete sections A, B & E
If this claim is for a new condition please
ensure that the pet’s full medical history from
all the vets that your pet has been registered
with is submitted with the claim form.
If this claim is for a continuation condition
then please ensure that the medical history
since the last claimed date of treatment is
submitted with the claim form.
PLEASE NOTE THAT IF ANY SECTION OF
THE CLAIM FORM IS NOT FILLED IN, OR
THE SUPPORTING INFORMATION IS NOT
SUBMITTED, THIS WILL DELAY YOUR
CLAIM.
If you are claiming for continuation
treatment you must submit claims every
3-6 months. Therefore, in order to save
paper, you do not need to submit a claim
for every visit to your vet but you can
batch the invoices up.
Your policy does not cover:
Any changes that you or your vet noticed
in your pet’s health or behaviour before the
policy started or any condition that arose
from those changes
Any condition that started within the first
14 days after the policy start date
Yes No Yes No
Yes No Yes No
