customer.homeprotect.co.uk
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20.82.210.72
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URL:
https://customer.homeprotect.co.uk/esigregistration?Agreement=000282785
Submission: On March 03 via manual from GB — Scanned from GB
Submission: On March 03 via manual from GB — Scanned from GB
Form analysis 1 forms found in the DOM
<form role="form" class="form-horizontal">
<div class="form-group">
<div class="col-md-12">
<div class="form-group row">
<div class="col-sm-2 col-md-3 col-lg-2" style="padding-right: 0px; width: auto;"><label for="inputValue" class="control-label" style="font-size: 0.85em; font-family: Quicksand, sans-serif;">Day</label><input autocomplete="off" type="text"
class="form-control" id="dobDay" placeholder="e.g. 1" name="dobDay" value="" style="height: 50px; font-size: 1em; width: 100px;"></div>
<div class="col-sm-2 col-md-3 col-lg-2" style="padding-right: 0px; width: auto;"><label for="inputValue" class="control-label" style="font-size: 0.85em; font-family: Quicksand, sans-serif;">Month</label><input autocomplete="off" type="text"
class="form-control" id="dobMonth" placeholder="e.g. 12" name="dobMonth" value="" style="height: 50px; font-size: 1em; width: 100px;"></div>
<div class="col-sm-2 col-md-3 col-lg-2" style="padding-right: 0px; width: auto;"><label for="inputValue" class="control-label" style="font-size: 0.85em; font-family: Quicksand, sans-serif;">Year</label><input autocomplete="off" type="text"
class="form-control" id="dobYear" placeholder="e.g. 1990" name="dobYear" value="" style="height: 50px; font-size: 1em; width: 175px;"></div>
</div>
</div>
</div>
</form>Text Content
WE VALUE YOUR PRIVACY We and our partners store and/or access information on a device, such as cookies and process personal data, such as unique identifiers and standard information sent by a device for personalised ads and content, ad and content measurement, and audience insights, as well as to develop and improve products. With your permission we and our partners may use precise geolocation data and identification through device scanning. You may click to consent to our and our partners’ processing as described above. Alternatively you may access more detailed information and change your preferences before consenting or to refuse consenting. Please note that some processing of your personal data may not require your consent, but you have a right to object to such processing. Your preferences will apply to a group of websites. You can change your preferences at any time by returning to this site or visit our privacy policy. MORE OPTIONSI AGREE You need to enable JavaScript to run this app. CREDIT AGREEMENT E-SIGN Need to sign your credit agreement? If so, please log in to use our secure signing facility. SURNAME (OF THE POLICY HOLDER) DATE OF BIRTH (OF THE POLICY HOLDER) Day Month Year DATE OF BIRTH POSTCODE (OF THE INSURED PROPERTY) Log in Homeprotect is a registered trademark and trading style of Avantia Insurance Ltd which is authorised and regulated by the Financial Conduct Authority (FS Register Number 304432). Home Insurance is underwritten by AXA Insurance and other reputable insurers. Copyright © 2023 Avantia Insurance Ltd|www.avantiagroup.co.uk|v1.0.563.122543 Homeprotect|Legal|Privacy policy|Cookies|Manage Privacy Settings Feedback