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Get Bupa Ipt Exemption Form

PM/1143/NOV14 00049 IPT EXEMPTION DECLARATION Please tick where appropriate Please complete and sign this form and return it in an envelope to Bupa Group and Member Administration Services Salford Quays Manchester M50 3XL. My permanent address is in the Channel Islands or Isle of Man Name BLOCK CAPITALS Bupa membership number Residency address Correspondence address if different to the residency address Postcode Telephone home Telephone work Signature Date. You are normally resident at this address ARE YOU EXEMPT If you meet the criteria above please complete the IPT exemption declaration form below and return it to Bupa. Please remember oo if IPT exemption has already been applied to your registration you must reconfirm your exemption annually at your renewal by returning the completed form below IPT exemption cannot be back-dated or applied to your membership midyear therefore you must apply for exemption when you join or renew your membership. Please see your membership guide for details of who is providing your cover. INSURANCE PREMIUM TAX EXEMPTION FORM HOW DOES IT AFFECT YOUR BUPA SUBSCRIPTIONS Do you know that the subscriptions you pay include IPT unless you declare that you are exempt For the purposes of Bupa s UK health insurance and dental insurance products you will only be exempt from paying IPT if you live in the Channel Islands or the Isle of Man as IPT is payable for all other parts of the UK. In some cases we hold more than one address for members so before we apply the exemption we need confirmation that a* you have a permanent address in the Channel Islands or Isle of Man and b. Bupa health insurance is provided by Bupa Insurance Limited* Registered in England and Wales No* 3956433. Bupa Insurance Services Limited* Registered in England and Wales No* 3829851. Bupa Insurance Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Bupa Insurance Services Limited is authorised and regulated by the Financial Conduct Authority. Registered office Bupa House 15-19 Bloomsbury Way London WC1A 2BA. INSURANCE PREMIUM TAX EXEMPTION FORM HOW DOES IT AFFECT YOUR BUPA SUBSCRIPTIONS Do you know that the subscriptions you pay include IPT unless you declare that you are exempt For the purposes of Bupa s UK health insurance and dental insurance products you will only be exempt from paying IPT if you live in the Channel Islands or the Isle of Man as IPT is payable for all other parts of the UK. In some cases we hold more than one address for members so before we apply the exemption we need confirmation that a* you have a permanent address in the Channel Islands or Isle of Man and b. Bupa health insurance is provided by Bupa Insurance Limited* Registered in England and Wales No* 3956433. Bupa Insurance Services Limited* Registered in England and Wales No* 3829851. Bupa Insurance Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.

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