Please complete this Form

    First Name *
    Last Name *
    Address *
    Post Code*
    Email *
    Date of Birth *
    Rank *
    Service Number *
    Phone *
    Cover Start Date *
    Service Type *

    I agree to take out started cover click here to see full cover detailsI accept the terms and conditions of the policy. Full details and important information can be found here


    I have taken reasonable care to give full and accurate answers to the questions asked and understand the insurers rely on my answers to give cover and the Mutual relies on them to accept me as a Member and if any information changes at any time, I will give the new information. I understand if I deliberately give false information or give information I know may not be accurate or complete the insurers can treat this cover as if it never existed, refuse to consider all claims, recover claims already paid and the Mutual may not refund any contribution. I also understand that if I am careless when I give information the insurers may change the terms of my cover or any excess, reduce the amount of a claim, cancel my cover or treat it as if it had never existed and the Mutual will give me a refund.

    Contacting you

    From time to time, we would like to send you information by post, e-mail, or telephone with news about the work we do to support the Military community and new offers or promotions that may interest you. By giving your contact details, you agree we can send you this information. We will limit the number times we contact you and will not sell or pass on any personal information to any other business for their marketing purposes. If you do not want to receive the information, please tell us. I prefer not to be contacted by

    Post & emailTelephone

    You can always tell us at any time if you change your mind and no longer want to receive information or change the way you receive it. You can do this by writing to us at The Military Mutual, PO Box 993, Portsmouth, PO1 9PS or emailing us at