Balens Mid-Term Amendment Form Individual and Commercial

Please confirm your NEW address below:

Address

Address line 1

Address line 2

Town/CityCounty

Postcode

Confirm your new correspondence address below:

Address line 1

Address line 2

Town/CityCounty

Postcode

Please note we may require further information to process this change.

To amend your sums insured, please provide details of what you would like to add/remove and the replacement cost of the item(s)

Rows	£
General contents, fixtures and fittings
Stock
Static computers
Electrical equipment
Laptops and/or mobile phones
Frontage, glass & signs
Stock of injectables/fillers
All Risks (portable equipment)
Vehicle All Risks (cover for theft from an unattended vehicle)
Loss of income/Increased cost of working

Please state the liability limit you would like to amend to

Which liability limit would you like to change?

Please note: Employers Liability is offered at a limit of liability of £10,000,000 as standard, this limit cannot be amended.

Please confirm your change of policyholder name

First NameLast Name

Please provide proof of name change

N.B. Your policy must be in your legal name.

Any changes to your Business/Entity name, please contact us on 01684 580 776 or Commercial@Balens.co.uk

Please confirm the reason for the change

Other

Please confirm the reason for requesting a duplicate schedule of insurance

Other

Please insert the activity/therapy you are looking to add

If you would like to add more than one activity/therapy, please separate them using a comma.

Please note: No cover will be in place for the activity described above until you receive confirmation from Balens that it has been added to your policy.
If adding this additional activity results in an additional premium being due, we will contact you with a quotation and payment details.

Please note: Any indemnity increase will not be in place until you receive confirmation from Balens that it has been added to your policy, and if this increase results in an additional premium being due, we will contact you with a quotation and payment details.

Please confirm the effective date

Date

Consequences of Dishonesty (Non-Disclosure/Misrepresentation)

If you lie or fail to disclose relevant information or are not being honest can result in the voiding of your policy, the rejection of claims, and difficulty obtaining insurance in the future.

If you would like to add the following cover to your policy, please select and one of our team will contact you to discuss this further:

June 2026 FP26174