NEXT HEALTHCASHPLAN HEALTHSCHEME DENTAL THERAPY +CARE4 USING YOUR HEALTH CASH PLAN

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1 HELP US TO HELP YOU To request further information on any of the products below - tick the box(es) of your choice... PLAN4LIFE CANCER INSURANCE TRAVEL INSURANCE Financial help when you need it most. With Plan4Life, if you are diagnosed with cancer you can claim a cash sum payment to spend in whichever way helps you most. Excellent value travel insurance with both European and Worldwide cover for holidays and business. Extended or special cover is also available and can be arranged to suit your particular circumstances. Visit for a quote today. FOOD INTOLERANCE TESTING Sometimes you can develop intolerances towards foods you eat every day. The food intolerance test from BHSF delivers a full report looking at the likely causes of intolerance and makes recommendations on preventative action. SONAL ACCIDENT INSURANCE Nobody likes to think about it, but accidents do happen. With the personal accident plan, you can claim for injuries resulting from an accident. USING YOUR WHAT TO DO With a level 2 personal policy at 9.00 per month, you could claim: 1) DENTAL BILL If you have an NHS dental check-up twice a year, and at one of those check-ups you need a filling...? NEXT PET INSURANCE If your much loved family pet is poorly, the last thing you want to worry about is how much it will cost to treat them. BHSF has teamed up with one if the country s leading pet insurers for high quality, low cost cover that you can trust. Visit for a quote today. GIFT VOUCHER FOR YOU AND A FRIEND VOUCHER Tell your friends about the range of benefits that BHSF offer, and if they buy a health cash plan or Plan4Life policy, as a small thank you WE WILL GIVE YOU BOTH A GIFT VOUCHER TO RECOMMEND A FRIEND TODAY CALL BHSF ON OR Or for more information on any of the products above call visit or 2) OPTICAL BILL If you have an eye-sight test and need glasses... 3) THERAPY BILL Six osteopathy treatment sessions at 40 per session You would still have 170 therapy benefit available to either claim additional osteopathy sessions, or other treatments such as physiotherapy, chiropractic treatment or acupuncture, within the benefit year 4) MAKE YOUR 1) CHOOSE YOUR COVER When paying for your treatment, ensure that you ask for a receipt POST CASH TOWARDS YOUR EVERYDAY HEALTHCARE BILLS SUCH AS For more information please call visit or Decide which level of health cash plan cover is best for you. For just the health cash plan, complete section A of the application form. 2) ADD CARE4 Do you want to add Care4 to your cover? If so, complete section B as well. 3) PAYROLL DEDUCTION LIFE INSURANCE FROM AS LITTLE AS ) POST YOUR FORM Fill out your claim form We will normally reimburse you and post it to BHSF with the appropriate amount along with your receipt within 3-5 working days DENTAL OPTICAL AND THERAPY TREATMENTS +CARE4 In all cases please ensure you complete section C of the application form. Return your completed application form to BHSF, FREEPOST BM2163, BIRMINGHAM, B16 8BR RECEIPT HEALTHCASHPLAN BHSF Limited and BHSF Services Limited Both organisations are registered at Darnley Road, Birmingham, B16 8TE Tel: Fax: Web: Calls to our office are recorded and may be monitored for training and security purposes. BHSF Limited registered in England number BHSF Services Limited registered in England number Authorised and regulated by The Financial Services Authority, and members of the Financial Ombudsman Service FOR OFFICE USE ONLY VISIT TO REQUEST A FORM * Examples of typical costs. See benefit table for maximum benefit levels. Dental and optical benefits are payable at 100% of the receipt value, and therapies are payable at 75% reimbursement, up to the appropriate maximum benefit under your chosen level of cover. All claims are subject to BHSF policy details; copies available on request. 01 TERRITORY Printed on environmentally friendly material from sustainable source OS482 01/11 APPLICATION FORM

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3 Monthly Premium (including insurance Premium Tax) Level 1 Level 2 Level 3 Level 4 Level 5 Personal (policyholder only) Make the most of a health cash plan Family (policyholder, partner and dependant children) Benefits Dental Reimbursment rate 100% Level 1 Level 2 Level 3 Level 4 Level MY FAMILY S HEALTH CASH PLAN I have always claimed for my glasses every two years or so. I recently changed to contact lenses and was pleased to find that I could continue claiming for my contacts in the same way. When my children reached 18, they wanted monthly disposable contact lenses as well. They now have their own health cash plans and claim for this cost every three months. BHSF s health cash plans have been a huge assistance in budgeting for my family s ongoing health costs. BHSF policyholder Sept 2010 LOOK AT THE TABLE OPPOSITE AND SEE WHICH LEVEL OF COVER BEST SUITS YOU AND YOUR FAMILY. THE HIGHER THE LEVEL OF COVER, THE MORE YOU CAN You can claim up to the maximum benefit each benefit period. Each insured person has their own maximum benefit, so the whole family* can enjoy the benefits of a health cash plan SEE HOW MUCH YOU COULD SAVE! Turn to USING YOUR at the back of this booklet * Children can be included on a family policy until their 18th birthday. Dental trauma Optical* Diagnostic consultation Therapies combined benefit including physiotherapy, osteopathy, chiropractic and acupuncture treatment Chiropody and homeopathy Hospital in-patient up to 35 nights Day-case surgery up to 10 occasions Recuperation payable automatically after a hospital in-patient claim of at least 10 consecutive nights Maternity (adult only) Hearing aids* Health screening* Health care navigator (adult only) Personal accident (adult only) Telephone helpline GP helpline 100% 100% 75% 75% 75% per night per event lump sum per child 75% 75% - up tp , , yes 25,000 50,000 0, , , hour, 365 days a year telephone helpline offering a counselling service on stress, family relationships, substance abuse and debt along with legal and financial advice and information on medical matters The GP helpline provides access to a GP 24 hours a day, 7 days a week. You can use the service as many times as you want, whenever it is convenient to you. Benefits are paid at the relevant percentage reimbursement of the cost incurred up to the appropriate maximum. * Every two benefit years. The amounts shown are maximum benefits payable every benefit period unless otherwise stated. Benefits are payable at an equal rate to all insured persons unless otherwise stated. Where benefit is provided for children it is limited to once times the maximum amount shown shared amongst all insured children. All benefits payable are subject to BHSF policy terms: copies available on request. 13 week qualifying period with the exception of maternity payment (10 month qualifying period) and for pre-existing medical conditions (2 years). All benefits and premiums supersede all publications prior to 1 December Insurance premium tax included at the applicabale rate. Issued by BHSF Limited, 2 Darnley Road, Birmingham B16 8TE. BHSF is authorised and regulated by the Financial Services Authority. E&OE OS482 01/11

4 CARE4 - CARING FOR THOSE YOU LEAVE BEHIND SONAL COVER 2.60 (policyholder only) Do you think about the future and how your family will manage when you pass away? PEACE OF MIND WITH CARE4 Did you know that a funeral can cost in excess of 4,000? FAMILY COVER Care4 has provided me with the reassurance that if the inevitable happens, my family will have the financial support they need. With Care4, 5,000 is payable to your estate after your death. The money can be spent any way, either to cover funeral expenses or maybe as an investment for your loved ones. The payment is made tax-free under current legislation. It will be an emotional time, and it doesn t need to be made any more difficult by worries of where the money will come from to pay for the funeral. Care4 is only available via your payroll if you are applying for a health cash plan at the same time, or if you already have a corporate cash plan through your employer. BHSF policyholder Sept 2010 Care4 provides you with the reassurance of knowing you have helped to reduce some of the emotional and financial stress on your family and friends at an upsetting time. You can choose between either personal or family Care4 cover. You can only select personal Care4 in conjunction with a personal cash plan and family Care4 in conjunction with a family cash plan. The premiums will be collected from your salary and paid to BHSF along with your health cash plan premium (policyholder and partner)

5 CARE4 YOUR QUESTIONS ANSWERED WHAT DO I PAY? The premium payable is 2.60 per month for personal cover, or 4.50 per month for family cover. WHO CAN APPLY? Anyone aged 18 to 69 inclusive is eligible to apply for cover. HOW DO I APPLY? Choose either personal or family cover; complete the application form at the back of this booklet and return it to BHSF. Subject to the terms of the insurance, it will be automatically renewed each month for as long as premiums are paid. Your cover will cease if you leave the employer through which your cover was arranged; or if you stop paying your premium. There is no surrender value to the insurance. HOW DO I KNOW IF I HAVE BEEN ACCEPTED? You will be sent a welcome pack containing your certificate of insurance and details on how to claim. WHEN DOES MY COVER START? From the effective date shown on your certificate of insurance. EXCLUSIONS? We will not pay the sum insured if death occurs: 1. As a result of a pre-existing condition or related condition, for which you received medication, advice or treatment, or experienced symptoms in the two years prior to the effective date, until you have not: - had any symptoms or tests, or - received any medication or other treatment, or - sought medical advice for an uninterrupted period of two years following the effective date. 2. Directly or indirectly as a result of alcohol or solvent abuse, or the taking of drugs except under the direction of a registered medical practitioner. 3. As a result of suicide (in the opinion of the underwriter). 4. Arising from war or civil war. 5. As a result of exposure to radiation or other nuclear risks. HOW TO? A claim form can be obtained from our helpdesk on We will provide the address to which the completed claim form must be sent at the time of claim. It should be submitted to our underwriters by the representative of your estate and should be accompanied by the original death certificate. The underwriters will also require evidence of your age and may require other information which will be advised as appropriate. Payment will be made to your estate subject to the terms and conditions of the insurance. WHO PROVIDES THE INSURANCE? Care4 is provided by BHSF Services Limited and underwritten by Jubilee, Lloyds s Syndicate 779. Both are authorised and regulated by the Financial Services Authority. The information contained within Your Questions Answered does not contain the full terms and conditions of the insurance contract and does not form part of the certificate of insurance. The full terms and conditions are provided in the certificate of insurance which will be sent to you on acceptance of your application. If you wish to receive a copy of the certificate of insurance beforehand, please call our helpdesk on CARE4 CARING FOR THOSE YOU LEAVE BEHIND TO APPLY FOR A CARE4 POLICY PLEASE COMPLETE THE APPLICATION FORM AT THE BACK OF THIS BOOKLET

6 IMPORTANT INFORMATION The Financial Services Authority (FSA) is an independent body that regulates the general insurance industry. It requires us to give you certain information so that you can decide if our services are right for you. This plan meets the demands and needs of those who wish to have assistance towards covering their everyday healthcare costs such as dental check-ups and treatment, eye tests and glasses and complementary therapy fees. In deciding to purchase this product you will not receive advice or personal recommendation from us. BHSF Limited of 2 Darnley Road, Birmingham B16 8TE is an insurance company authorised and regulated by the Financial Services Authority. Our registration number is Our permitted business includes advising on and effecting non-investment insurance contracts. Details of our registration can be checked at or by telephoning As an insurer, BHSF Limited offers only its own cash plan products in isolation; where appropriate it may offer the most suitable of its products, but only in comparison with other products underwritten by BHSF. You have 14 days from the date you receive your policy to review it. If you are not completely satisfied with the policy, simply notify us in writing within 14 days and we will cancel it. Provided a claim has not been paid, we will refund any premium collected. BHSF Services Limited (who administer the Care4 cover), of 2 Darnley Road, Birmingham B16 8TE is an Intermediary authorised and regulated by the Financial Services Authority. Our registration number is Our permitted business includes advising on and effecting non-investment insurance contracts. Details of our registration can be checked at or by telephoning Care4 is underwritten by Jubilee, Lloyd s Syndicate 779 who are authorised and regulated by the Financial Services Authority. This insurance meets the demands and needs of those wishing to secure a lump sum payment in the event of the death of an insured person. BHSF Services Limited is a wholly owned subsidiary of BHSF Group Limited. BHSF Services Limited only offers products from selected insurers for travel insurance, personal accident insurance and life insurance. Products are offered in isolation and without comparison to the wider market. A list of insurers offered can be provided on request. You have 30 days from the date we issue your Care4 certificate of insurance to review it. If you are not completely satisfied with the insurance, simply notify us in writing within 30 days and we will cancel your policy. Provided a claim has not been made, we will refund any premium collected. BHSF Limited, BHSF Services Limited and Jubilee, Lloyd s Syndicate 779 are covered by the Financial Services Compensation Scheme (FSCS). You may be entitled to compensation from the scheme if they are unable to meet their obligations. Entitlement will depend on the type of business and the circumstances of the claim. Further information about the compensation scheme is available on the FSCS website If you wish to register a complaint, please do so in writing to BHSF, 2 Darnley Road, Birmingham B16 8TE or by telephoning , quoting your policy or certificate of insurance number. If you are not satisfied with the outcome of the complaint, you may be entitled to refer it to the Financial Ombudsman Service. NEXT? WHAT TO DO 1) CHOOSE YOUR COVER Decide which level of health cash plan cover is best for you. For just the health cash plan, complete section A of the application form. 2) ADD CARE4 Do you want to add Care4 to your cover? If so, complete section B as well. 3) PAYROLL DEDUCTION In all cases please ensure you complete section C of the application form. 4) POST YOUR FORM Return your completed application form to BHSF, FREEPOST BM2163, BIRMINGHAM, B16 8BR

7 A Applicants are requested to complete all applicable sections and return the entire form to BHSF, FREEPOST BM2163, BIRMINGHAM B16 8BR. All insured persons must be permanently resident at the same address. Any dependant children to be covered must be under 18 years of age. 1 Title Surname Forename Address County Telephone 2 APPLICATION FORM SONAL DETAILS EMPLOYER DETAILS Employer s name Employer s address Town Postcode National Insurance number OS482 01/11 GROUP NUMBER REP NUMBER 5 IF YOU ARE, OR HAVE PREVIOUSLY BEEN INSURED BY BHSF Policy number Last premium date Where was it paid? State either employer s name or direct to BHSF 6 DECLARATION Please tick appropriate box. I, or persons to be covered, have a medical condition to declare (please give details) Name: Condition: Continue on a separate piece of paper if necessary No pre-existing medical condition to declare Postcode 3 Please tick the policy of your choice (tick one box only) 4 Payroll number I wish my application to cover my partner, whose full name and date of birth is: Title Surname Forename I wish my application to cover my children, whose full names and dates of birth are: Name Name Name CHOICE OF COVER SONAL POLICY LEVEL 1 LEVEL 2 LEVEL 3 LEVEL 4 LEVEL COVER FOR YOUR PARTNER AND FAMILY FAMILY POLICY LEVEL 1 LEVEL 2 LEVEL 3 LEVEL 4 LEVEL If more than 3 children are to be covered please supply details on a seperate piece of paper I declare that I, and, to the best of my knowledge, all persons for whom benefit may be claimed under the terms of my chosen policy are (other than as declared above) in good health. As far as I am aware none of the applicants are receiving, or been informed of the need for treatment that could give rise to a claim under the hospital-related benefit which BHSF provides other than as declared above. I understand that: i) no hospital-related claim will be paid during the first two years of my policy in respect of any medical condition which existed or was being investigated before cover commenced and ii) BHSF may wish to verify medical information to support a hospital-related claim. I agree to abide by the policy terms, and I acknowledge that they may be varied, as may the range or rates of benefits or premiums, if deemed necessary. I declare that all the information I have given on this application form is true, and that, if found to the contrary, claims may be rejected or the policy may be cancelled at any time. In signing this application form I understand that my personal information will be used in accordance with the Data Protection Act 1998 by BHSF (and relevant BHSF Group companies) and by other companies who may provide a service under this insurance. This information may also be used for the efficient administration of the insurance, to monitor and continue to improve these services and for the detection and prevention of fraud. SIGNATURE Please ensure that you have signed and dated this box Signature Date We may advise you, from time to time, about other products and services which may be of interest to you. If you do not wish to receive this information please tick the box.

8 B 7 My full name and date of birth is: Title Surname Forename I wish my application to cover my partner, whose details are: Title Surname Forename I am applying to BHSF Services Limited for life insurance cover in the sum of 5,000. I understand that no cover is available for any pre-existing medical condition or related medical condition until a period of two years has passed during which there have been no symptoms, tests, medication, other treatment or medical advice concerning such condition. I wish to take out Care4 insurance as indicated. I understand that variation can be made to the sum insured and/or monthly premiums if I am given at least 30 days notice of the change at my last known address. In signing this application form I understand that my personal information will be used in accordance with the Data Protection Act 1998 by BHSF Services Limited (and relevant BHSF Group companies), Jubilee, Lloyd s Syndicate 779 and by other companies who may provide a service under this insurance. This information may also be used for the efficient administration of the insurance, to monitor and continue to improve these services, and for the detection and prevention of fraud. Please ensure that you have signed and dated this box Signature (Family cover is only available if you have selected a family health cash plan policy) 8 Please tick the policy of your choice (tick one box only) 9 CARE4 APPLICATION FORM SONS TO BE INSURED CHOICE OF COVER SONAL COVER DECLARATION SIGNATURE 2.60 FAMILY COVER Date OS482 01/11 GROUP NUMBER REP NUMBER 4.50 We may advise you, from time to time, about other products and services which may be of interest to you. If you do not wish to receive this information please tick the box. C 10 Employer s name Employer s address Postcode Payroll number Please deduct the appropriate amount of premium from my pay and apply it to my BHSF policy as follows (tick one box only) Please also deduct the appropriate amount from my pay in respect of my Care4 policy as follows (tick one box only) Title Surname Forename Address County Payroll number Town Postcode I hereby authorise the deduction from my salary/wages of the amount indicated (or such future amounts as may be required to secure the benefits of the selected policies) each month. Please remit same to BHSF on my behalf at the agreed intervals until further notice from me. This cancels any previous BHSF deductions authorised by me. Please ensure that you have signed and dated this box Signature PAYROLL DEDUCTION AUTHORITY FORM EMPLOYER DETAILS 11 PREMIUM SONAL POLICY LEVEL 1 LEVEL LEVEL LEVEL LEVEL CARE4 LIFE INSURANCE PREMIUM 13 SONAL COVER APPLICANT S DETAILS SIGNATURE FAMILY POLICY LEVEL 1 LEVEL 2 LEVEL 3 LEVEL 4 LEVEL 5 FAMILY COVER TOTAL PREMIUM TO BE DEDUCTED FROM MY SALARY Date Please return entire form to BHSF, Freepost BM2163, Birmingham B16 8BR

9 HELP US TO HELP YOU To request further information on any of the products below - tick the box(es) of your choice... PLAN4LIFE CANCER INSURANCE TRAVEL INSURANCE Financial help when you need it most. With Plan4Life, if you are diagnosed with cancer you can claim a cash sum payment to spend in whichever way helps you most. Excellent value travel insurance with both European and Worldwide cover for holidays and business. Extended or special cover is also available and can be arranged to suit your particular circumstances. Visit for a quote today. FOOD INTOLERANCE TESTING Sometimes you can develop intolerances towards foods you eat every day. The food intolerance test from BHSF delivers a full report looking at the likely causes of intolerance and makes recommendations on preventative action. SONAL ACCIDENT INSURANCE Nobody likes to think about it, but accidents do happen. With the personal accident plan, you can claim for injuries resulting from an accident. USING YOUR WHAT TO DO With a level 2 personal policy at 9.00 per month, you could claim: 1) DENTAL BILL If you have an NHS dental check-up twice a year, and at one of those check-ups you need a filling...? NEXT PET INSURANCE If your much loved family pet is poorly, the last thing you want to worry about is how much it will cost to treat them. BHSF has teamed up with one if the country s leading pet insurers for high quality, low cost cover that you can trust. Visit for a quote today. GIFT VOUCHER FOR YOU AND A FRIEND VOUCHER Tell your friends about the range of benefits that BHSF offer, and if they buy a health cash plan or Plan4Life policy, as a small thank you WE WILL GIVE YOU BOTH A GIFT VOUCHER TO RECOMMEND A FRIEND TODAY CALL BHSF ON OR Or for more information on any of the products above call visit or 2) OPTICAL BILL If you have an eye-sight test and need glasses... 3) THERAPY BILL Six osteopathy treatment sessions at 40 per session You would still have 170 therapy benefit available to either claim additional osteopathy sessions, or other treatments such as physiotherapy, chiropractic treatment or acupuncture, within the benefit year 4) MAKE YOUR 1) CHOOSE YOUR COVER When paying for your treatment, ensure that you ask for a receipt POST CASH TOWARDS YOUR EVERYDAY HEALTHCARE BILLS SUCH AS For more information please call visit or Decide which level of health cash plan cover is best for you. For just the health cash plan, complete section A of the application form. 2) ADD CARE4 Do you want to add Care4 to your cover? If so, complete section B as well. 3) PAYROLL DEDUCTION LIFE INSURANCE FROM AS LITTLE AS ) POST YOUR FORM Fill out your claim form We will normally reimburse you and post it to BHSF with the appropriate amount along with your receipt within 3-5 working days DENTAL OPTICAL AND THERAPY TREATMENTS +CARE4 In all cases please ensure you complete section C of the application form. Return your completed application form to BHSF, FREEPOST BM2163, BIRMINGHAM, B16 8BR RECEIPT HEALTHCASHPLAN BHSF Limited and BHSF Services Limited Both organisations are registered at Darnley Road, Birmingham, B16 8TE Tel: Fax: Web: Calls to our office are recorded and may be monitored for training and security purposes. BHSF Limited registered in England number BHSF Services Limited registered in England number Authorised and regulated by The Financial Services Authority, and members of the Financial Ombudsman Service FOR OFFICE USE ONLY VISIT TO REQUEST A FORM * Examples of typical costs. See benefit table for maximum benefit levels. Dental and optical benefits are payable at 100% of the receipt value, and therapies are payable at 75% reimbursement, up to the appropriate maximum benefit under your chosen level of cover. All claims are subject to BHSF policy details; copies available on request. 01 TERRITORY Printed on environmentally friendly material from sustainable source OS482 01/11 APPLICATION FORM

10 HELP US TO HELP YOU To request further information on any of the products below - tick the box(es) of your choice... PLAN4LIFE CANCER INSURANCE TRAVEL INSURANCE Financial help when you need it most. With Plan4Life, if you are diagnosed with cancer you can claim a cash sum payment to spend in whichever way helps you most. Excellent value travel insurance with both European and Worldwide cover for holidays and business. Extended or special cover is also available and can be arranged to suit your particular circumstances. Visit for a quote today. FOOD INTOLERANCE TESTING Sometimes you can develop intolerances towards foods you eat every day. The food intolerance test from BHSF delivers a full report looking at the likely causes of intolerance and makes recommendations on preventative action. SONAL ACCIDENT INSURANCE Nobody likes to think about it, but accidents do happen. With the personal accident plan, you can claim for injuries resulting from an accident. USING YOUR WHAT TO DO With a level 2 personal policy at 9.00 per month, you could claim: 1) DENTAL BILL If you have an NHS dental check-up twice a year, and at one of those check-ups you need a filling...? NEXT PET INSURANCE If your much loved family pet is poorly, the last thing you want to worry about is how much it will cost to treat them. BHSF has teamed up with one if the country s leading pet insurers for high quality, low cost cover that you can trust. Visit for a quote today. GIFT VOUCHER FOR YOU AND A FRIEND VOUCHER Tell your friends about the range of benefits that BHSF offer, and if they buy a health cash plan or Plan4Life policy, as a small thank you WE WILL GIVE YOU BOTH A GIFT VOUCHER TO RECOMMEND A FRIEND TODAY CALL BHSF ON OR Or for more information on any of the products above call visit or 2) OPTICAL BILL If you have an eye-sight test and need glasses... 3) THERAPY BILL Six osteopathy treatment sessions at 40 per session You would still have 170 therapy benefit available to either claim additional osteopathy sessions, or other treatments such as physiotherapy, chiropractic treatment or acupuncture, within the benefit year 4) MAKE YOUR 1) CHOOSE YOUR COVER When paying for your treatment, ensure that you ask for a receipt POST CASH TOWARDS YOUR EVERYDAY HEALTHCARE BILLS SUCH AS For more information please call visit or Decide which level of health cash plan cover is best for you. For just the health cash plan, complete section A of the application form. 2) ADD CARE4 Do you want to add Care4 to your cover? If so, complete section B as well. 3) PAYROLL DEDUCTION LIFE INSURANCE FROM AS LITTLE AS ) POST YOUR FORM Fill out your claim form We will normally reimburse you and post it to BHSF with the appropriate amount along with your receipt within 3-5 working days DENTAL OPTICAL AND THERAPY TREATMENTS +CARE4 In all cases please ensure you complete section C of the application form. Return your completed application form to BHSF, FREEPOST BM2163, BIRMINGHAM, B16 8BR RECEIPT HEALTHCASHPLAN BHSF Limited and BHSF Services Limited Both organisations are registered at Darnley Road, Birmingham, B16 8TE Tel: Fax: Web: Calls to our office are recorded and may be monitored for training and security purposes. BHSF Limited registered in England number BHSF Services Limited registered in England number Authorised and regulated by The Financial Services Authority, and members of the Financial Ombudsman Service FOR OFFICE USE ONLY VISIT TO REQUEST A FORM * Examples of typical costs. See benefit table for maximum benefit levels. Dental and optical benefits are payable at 100% of the receipt value, and therapies are payable at 75% reimbursement, up to the appropriate maximum benefit under your chosen level of cover. All claims are subject to BHSF policy details; copies available on request. 01 TERRITORY Printed on environmentally friendly material from sustainable source OS482 01/11 APPLICATION FORM

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