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<div id="" data-propsId="92ad9c65510a4de3a779a360db7e8e41" class="react-component" data-name="HeaderBanner"><div id="react_0HNOP9HHNMB7C"><div class="headerBanner headerBanner--alignLeft headerBanner--clover headerBanner--overlay theme--text-white headerBanner--headlineOnly theme-white visible"><div class="headerBanner__image"><div class=""><picture class="bg-image"></picture><div class="mask"><svg version="1.1" x="0px" y="0px" viewBox="0 0 1400 150" width="1400" height="150" fetchPriority="high" loading="eager" decoding="async" preserveAspectRatio="xMinYMax"><defs><linearGradient id="headermask-gradbg"><stop offset="0%" stop-color="#ffffff"></stop><stop offset="100%" stop-color="#ffffff"></stop></linearGradient></defs><path d="M1400,151H0V133s135,23,383,13C618,136,892,120,1400,0" fill="url(#headermask-gradbg)"></path></svg></div></div></div><div class="container"><div class="headerBanner__body"><div class="headerheadline"><h1 class="headerBanner__category"><a id="8BD9CAEB75714E68907C9914844C6F23-BCC96E15C9E244E3BA9E20865DAF1B78https://www.lv.com/life-contact-us#heritage-policies" href="https://www.lv.com/life-contact-us#heritage-policies">Heritage policies</a></h1><h2 class="headerBanner__body__headline">Pre 1998 policy tracing form</h2></div></div></div></div></div></div>
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<div><section class="module product-features theme-white module--product module-noCurveTop module-curve-bottom-concave      theme--text-green "><div class="wrapper"><div class="container product-features__container"><div class="columns@md product-features__main"><div><div class="head  theme-text-undefined moduleheader"><div class="head__main"><p class="title h2">Please fill in the form the best you can</p></div></div></div><div><div class="editablediv product-features__body bulleted"><ul>
    <li>To make sure that we can find your policy, please have your policy document in front of you when completing the form. If you don't have the policy documentation to hand you may want to give us a call on <strong>0800 681 6294</strong>.</li>
    <li><a href="/data-protection" title="Find out how we use your personal information">Find out how we use your personal information</a></li>
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<div id="" data-propsId="607c3c86010f4bc9ac73351f309ea663" class="react-component" data-name="Form"><div id="react_0HNOP9HHNMBC8"><div><section class="module form theme-warm-grey module--product module-noCurveTop module-noCurveBottom module-curve-before-concave      "><div class="wrapper"><div class="container form__container"><form data-validateall="true" autoComplete="off" action="/life/api/form/submit/Lifeservicing" method="post"><div></div><div><fieldset><div class="xx"><div class="xx__left"><div class="legend-wrapper"><legend>About your policy</legend><h2 class="editable">About your policy</h2></div></div><div class="xx__right"><div class="editablediv form__header">If you&#39;re not sure about any of the following policy questions, you can still submit the form - we&#39;ll contact you if we have any questions.</div><div class="form-field form-field--text form-field--valid" for="policy number"><label class="form-field__label" for="policy number" data-label="Policy number"><span class="labelText">Policy number</span><span class="fieldErrors" for="policy number"></span></label><div class="form-field__field"><input class="lg" placeholder="Please enter your policy number" data-validate="true" type="text" id="policy number" name="policy number"/></div></div><div class="form-field form-field--text form-field--valid" for="Name of the insured"><label class="form-field__label" for="Name of the insured" data-label="Name of the insured"><span class="labelText">Name of the insured <em title="Required">*</em></span><span class="fieldErrors" for="Name of the insured"></span></label><div class="form-field__field"><input data-required="true" class="lg" placeholder="Please enter the name of the life insured" data-validate="true" type="text" id="Name of the insured" required="" name="Name of the insured"/></div></div><div class="form-field form-field--date form-field--valid" for="Date of birth of life insured"><label class="form-field__label" for="Date of birth of life insured" data-label="Date of birth of the life insured"><span class="labelText">Date of birth of the life insured</span><span class="fieldErrors" for="Date of birth of life insured"></span></label><div class="form-field__field"><input date-format="mm/dd/yyyy" class="" placeholder="dd/mm/yyy" data-validate="true" type="date" id="Date of birth of life insured" name="Date of birth of life insured"/></div></div><div class="form-field form-field--textarea form-field--valid" for="Address history of the life insured"><label class="form-field__label" for="Address history of the life insured" data-label="Address history"><span class="labelText">Address history</span><span class="fieldErrors" for="Address history of the life insured"></span></label><span class="form-field__additional">Full address of the insured</span><div class="form-field__field"><textarea class="lg" placeholder="Please enter the full address of the life insured" data-validate="true" name="Address history of the life insured" id="Address history of the life insured"></textarea></div></div><div class="form-field form-field--textarea form-field--valid" for="Address history of the insured"><label class="form-field__label" for="Address history of the insured" data-label="Address history of the life insured"><span class="labelText">Address history of the life insured</span><span class="fieldErrors" for="Address history of the insured"></span></label><div class="form-field__field"><textarea class="lg" placeholder="Please provide any previous addresses of the life insured" data-validate="true" name="Address history of the insured" id="Address history of the insured"></textarea></div></div><div class="form-field form-field--radio form-field--valid" for="Has insured passed away"><label class="form-field__label" for="Has insured passed away" data-label="Has the life insured passed away? "><span class="labelText">Has the life insured passed away? </span><span class="fieldErrors" for="Has insured passed away"></span></label><div class="form-field__field"><ul><li><input type="radio" id="Has insured passed awayYes0" name="Has insured passed away" value="Yes"/><label for="Has insured passed awayYes0"><span></span>Yes</label></li><li><input type="radio" id="Has insured passed away
No1" name="Has insured passed away" value="
No"/><label for="Has insured passed away
No1"><span></span>
No</label></li></ul></div></div><div class="form-field form-field--text form-field--valid" for="Year of death"><label class="form-field__label" for="Year of death" data-label="Year of death"><span class="labelText">Year of death</span><span class="fieldErrors" for="Year of death"></span></label><span class="form-field__additional">If your answer was yes, please confirm year of death</span><div class="form-field__field"><input class="lg" placeholder="Please enter the year the life insured passed" data-validate="true" type="text" id="Year of death" name="Year of death"/></div></div><div class="form-field form-field--text form-field--valid" for="Date of death"><label class="form-field__label" for="Date of death" data-label="Date of death"><span class="labelText">Date of death</span><span class="fieldErrors" for="Date of death"></span></label><span class="form-field__additional">Please confirm date of death too if you know this</span><div class="form-field__field"><input class="lg" placeholder="Please enter the date the life insured passed" data-validate="true" type="text" id="Date of death" name="Date of death"/></div></div><div class="form-field form-field--text form-field--valid" for="Name of proposer"><label class="form-field__label" for="Name of proposer" data-label="Name of proposer (if different to insured)"><span class="labelText">Name of proposer (if different to insured)</span><span class="fieldErrors" for="Name of proposer"></span></label><div class="form-field__field"><input class="lg" placeholder="Please enter the name of the proposer" data-validate="true" type="text" id="Name of proposer" name="Name of proposer"/></div></div><div class="form-field form-field--textarea form-field--valid" for="any name changes"><label class="form-field__label" for="any name changes" data-label="Name changes"><span class="labelText">Name changes</span><span class="fieldErrors" for="any name changes"></span></label><span class="form-field__additional">Please detail any name changes for the life insured since the policy was taken out</span><div class="form-field__field"><textarea class="lg" placeholder="Please enter any name changes" data-validate="true" name="any name changes" id="any name changes"></textarea></div></div><div class="form-field form-field--textarea form-field--valid" for="Full address of proposer if different"><label class="form-field__label" for="Full address of proposer if different" data-label="Full address of proposer (if different to the insured)"><span class="labelText">Full address of proposer (if different to the insured)</span><span class="fieldErrors" for="Full address of proposer if different"></span></label><div class="form-field__field"><textarea class="lg" placeholder="Please enter the full address of proposer (if different to the insured)" data-validate="true" name="Full address of proposer if different" id="Full address of proposer if different"></textarea></div></div><div class="form-field form-field--textarea form-field--valid" for="Address history of the proposer"><label class="form-field__label" for="Address history of the proposer" data-label="Address history of the proposer (if different to the insured)"><span class="labelText">Address history of the proposer (if different to the insured)</span><span class="fieldErrors" for="Address history of the proposer"></span></label><div class="form-field__field"><textarea class="lg" placeholder="Please provide any previous addresses of the proposer (if different to the insured)" data-validate="true" name="Address history of the proposer" id="Address history of the proposer"></textarea></div></div><div class="form-field form-field--date form-field--valid" for="Date of entry"><label class="form-field__label" for="Date of entry" data-label="Date of entry"><span class="labelText">Date of entry</span><span class="fieldErrors" for="Date of entry"></span></label><span class="form-field__additional">Please enter the date the policy was taken out. This must be different to the date of birth. 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      </g></svg></span></div><div class="editablediv form-field__info "><div>Here's an example: 22, 21, 79G, 42, 80E</div></div></div><div class="form-field form-field--text form-field--valid" for="Sum assured"><label class="form-field__label" for="Sum assured" data-label="Sum assured"><span class="labelText">Sum assured</span><span class="fieldErrors" for="Sum assured"></span></label><span class="form-field__additional">This may be in pre-decimal amount</span><div class="form-field__field"><input class="lg" placeholder="Please enter the sum assured" data-validate="true" type="text" id="Sum assured" name="Sum assured"/></div></div><div class="form-field form-field--text form-field--valid" for="Policy term"><label class="form-field__label" for="Policy term" data-label="Policy term"><span class="labelText">Policy term</span><span class="fieldErrors" for="Policy term"></span></label><div class="form-field__field"><input class="lg" placeholder="Please enter the policy term" data-validate="true" type="text" id="Policy term" name="Policy term"/></div></div><div class="form-field form-field--text form-field--valid" for="Endorsements"><label class="form-field__label" for="Endorsements" data-label="Endorsements"><span class="labelText">Endorsements</span><span class="fieldErrors" for="Endorsements"></span></label><span class="form-field__additional">Please list any endorsements shown (these may be in form of hand-writing on the policy or as a small sticker stuck to the document)</span><div class="form-field__field"><input class="lg" placeholder="Please enter any endorsements shown" data-validate="true" type="text" id="Endorsements" name="Endorsements"/></div></div><div class="form-field form-field--textarea form-field--valid" for="Additional references"><label class="form-field__label" for="Additional references" data-label=""><span class="fieldErrors" for="Additional references"></span></label><span class="form-field__additional">Any additional references detailed on the policy document or correspondence from LV=</span><div class="form-field__field"><textarea class="lg" placeholder="Please enter any additional references" data-validate="true" name="Additional references" id="Additional references"></textarea></div></div><div class="form-field form-field--radio form-field--valid" for="Premium receipt books"><label class="form-field__label" for="Premium receipt books" data-label="Premium receipt books"><span class="labelText">Premium receipt books</span><span class="fieldErrors" for="Premium receipt books"></span></label><span class="form-field__additional">Have you got any premium receipt books relating to this policy?</span><div class="form-field__field"><ul><li><input type="radio" id="Premium receipt booksYes0" name="Premium receipt books" value="Yes"/><label for="Premium receipt booksYes0"><span></span>Yes</label></li><li><input type="radio" id="Premium receipt books
No1" name="Premium receipt books" value="
No"/><label for="Premium receipt books
No1"><span></span>
No</label></li></ul></div></div><div class="form-field form-field--textarea form-field--valid" for="Additional comments"><label class="form-field__label" for="Additional comments" data-label=""><span class="fieldErrors" for="Additional comments"></span></label><span class="form-field__additional">Please provide any comments that will assist us with tracing any policies and let us know what you would like to do if a policy is found.</span><div class="form-field__field"><textarea class="lg" placeholder="Please enter any additional comments" data-validate="true" name="Additional comments" id="Additional comments"></textarea></div></div><div class="form-field form-field--checkbox form-field--valid" for="Document"><label class="form-field__label" for="Document" data-label="If you have a copy of the original document you can email it to CustomerReconnection@LV.com. We&amp;#39;d also like to see pages from the premium receipt books if you have them. Please email photos of every page or photos of any additional policy documents to CustomerReconnection@LV.com."><span class="labelText">If you have a copy of the original document you can email it to <a href="/cdn-cgi/l/email-protection" class="__cf_email__" data-cfemail="7635030502191b13042413151918181315021f1918363a205815191b">[email&#160;protected]</a>. We&#39;d also like to see pages from the premium receipt books if you have them. Please email photos of every page or photos of any additional policy documents to <a href="/cdn-cgi/l/email-protection" class="__cf_email__" data-cfemail="e1a29492958e8c8493b384828e8f8f848295888e8fa1adb7cf828e8c">[email&#160;protected]</a>.</span><span class="fieldErrors" for="Document"></span></label><div class="form-field__field"><ul></ul></div></div></div></div></fieldset><fieldset><div class="xx"><div class="xx__left"><div class="legend-wrapper"><legend>About you</legend><h2 class="editable">About you</h2></div></div><div class="xx__right"><div class="form-field form-field--text form-field--valid" for="Title"><label class="form-field__label" for="Title" data-label="Your title"><span class="labelText">Your title</span><span class="fieldErrors" for="Title"></span></label><div class="form-field__field"><input class="lg" placeholder="Please enter your title" data-validate="true" type="text" id="Title" name="Title"/></div></div><div class="form-field form-field--text form-field--valid" for="First name"><label class="form-field__label" for="First name" data-label="First name"><span class="labelText">First name <em title="Required">*</em></span><span class="fieldErrors" for="First name"></span></label><div class="form-field__field"><input data-required="true" class="lg" placeholder="Please enter your first name" data-validate="true" type="text" id="First name" required="" name="First name"/></div></div><div class="form-field form-field--text form-field--valid" for="Surname"><label class="form-field__label" for="Surname" data-label="Surname"><span class="labelText">Surname <em title="Required">*</em></span><span class="fieldErrors" for="Surname"></span></label><div class="form-field__field"><input data-required="true" class="lg" placeholder="Please enter your surname" data-validate="true" type="text" id="Surname" required="" name="Surname"/></div></div><div class="form-field form-field--date form-field--valid" for="date of birth"><label class="form-field__label" for="date of birth" data-label="Date of birth"><span class="labelText">Date of birth <em title="Required">*</em></span><span class="fieldErrors" for="date of birth"></span></label><div class="form-field__field"><input data-required="true" date-format="mm/dd/yyyy" class="" placeholder="Please select your date of birth" data-validate="true" type="date" id="date of birth" required="" name="date of birth"/></div></div><div class="form-field form-field--textarea form-field--valid" for="Full address"><label class="form-field__label" for="Full address" data-label="Full address"><span class="labelText">Full address <em title="Required">*</em></span><span class="fieldErrors" for="Full address"></span></label><div class="form-field__field"><textarea class="lg" placeholder="Please enter your address" data-validate="true" name="Full address" id="Full address" required=""></textarea></div></div><div class="form-field form-field--text form-field--valid" for="postcode"><label class="form-field__label" for="postcode" data-label="Postcode"><span class="labelText">Postcode <em title="Required">*</em></span><span class="fieldErrors" for="postcode"></span></label><div class="form-field__field"><input data-required="true" class="lg" placeholder="Please enter your postcode" data-validate="true" type="text" id="postcode" required="" name="postcode"/></div></div><div class="form-field form-field--text form-field--valid" for="Telephone number"><label class="form-field__label" for="Telephone number" data-label="Telephone number"><span class="labelText">Telephone number <em title="Required">*</em></span><span class="fieldErrors" for="Telephone number"></span></label><div class="form-field__field"><input data-required="true" class="lg" placeholder="Please enter your telephone number" data-validate="true" type="text" id="Telephone number" required="" name="Telephone number"/></div></div><div class="form-field form-field--email form-field--valid" for="Email address"><label class="form-field__label" for="Email address" data-label="Email address"><span class="labelText">Email address <em title="Required">*</em></span><span class="fieldErrors" for="Email address"></span></label><div class="form-field__field"><input data-email="true" data-required="true" class="lg" placeholder="Please enter your email address" data-validate="true" type="email" id="Email address" required="" name="Email address"/></div></div></div></div></fieldset><div class="form-field form-field--button"><button class="cta cta--sm cta--primary cta--no-icon" name="submit">Submit</button></div></div></form></div></div></section></div></div></div>
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One of our advisers will be in touch shortly\u003c/p\u003e","image":""},"failure":{"backText":"","heading":"Oops, something went wrong","content":"\u003cdiv style=\u0022display: none;\u0022\u003e\u0026nbsp;\u003c/div\u003e\n\u003cp\u003eSorry, there has been a problem sending through your request.\u003c/p\u003e","image":""},"editButton":"","groups":[{"id":"policy questions","name":"About your policy","subheading":"If you\u0026#39;re not sure about any of the following policy questions, you can still submit the form - we\u0026#39;ll contact you if we have any questions.","image":"","editButton":"","fields":[{"type":"text","placeholder":"Please enter your policy number","size":"lg","maxLength":null,"minLength":0,"id":"policy number","name":"","label":"Policy number","additional":"","info":"","value":null,"customError":"Please enter a valid Policy number","isRequired":false,"editButton":""},{"type":"text","placeholder":"Please enter the name of the life insured","size":"lg","maxLength":null,"minLength":0,"id":"Name of the insured","name":"","label":"Name of the insured","additional":"","info":"","value":null,"customError":"Please tell us the name of the insured person","isRequired":true,"editButton":""},{"placeholder":"","type":"date","id":"Date of birth of life insured","name":"","label":"Date of birth of the life insured","additional":"","info":"","value":null,"customError":"Please enter a valid Date of birth of the life insured","isRequired":false,"editButton":""},{"type":"textarea","placeholder":"Please enter the full address of the life insured","size":"lg","maxLength":null,"minLength":0,"id":"Address history of the life insured","name":"Address history of the life insured","label":"Address history","additional":"Full address of the insured","info":"","value":null,"customError":"Please enter a valid Address history","isRequired":false,"editButton":""},{"type":"textarea","placeholder":"Please provide any previous addresses of the life insured","size":"lg","maxLength":null,"minLength":0,"id":"Address history of the insured","name":"Address history of the insured","label":"Address history of the life insured","additional":"","info":"","value":null,"customError":"Please enter a valid Address history of the life insured","isRequired":false,"editButton":""},{"type":"radio","options":[{"label":"Yes","value":"Yes","selected":false},{"label":"\r\nNo","value":"\r\nNo","selected":false}],"id":"Has insured passed away","name":"Has insured passed away","label":"Has the life insured passed away? ","additional":"","info":"","value":"","customError":"Please enter a valid Has the life insured passed away? 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This must be different to the date of birth. Without it we\u0026#39;ll be unable to investigate your enquiry","info":"","value":null,"customError":"Please enter a valid Date of entry","isRequired":false,"editButton":""},{"type":"text","placeholder":"Please enter the premium amount","size":"lg","maxLength":null,"minLength":0,"id":"Premium amount","name":"","label":"Premium amount","additional":"This may be in pre-decimal amount","info":"","value":null,"customError":"Please enter a valid Premium amount","isRequired":false,"editButton":""},{"type":"text","placeholder":"Please enter the table number","size":"lg","maxLength":null,"minLength":0,"id":"Table number","name":"","label":"Table number","additional":"","info":"Here\u0027s an example: 22, 21, 79G, 42, 80E","value":null,"customError":"Please enter a valid Table number","isRequired":false,"editButton":""},{"type":"text","placeholder":"Please enter the sum assured","size":"lg","maxLength":null,"minLength":0,"id":"Sum assured","name":"","label":"Sum assured","additional":"This may be in pre-decimal amount","info":"","value":null,"customError":"Please enter a valid Sum assured","isRequired":false,"editButton":""},{"type":"text","placeholder":"Please enter the policy term","size":"lg","maxLength":null,"minLength":0,"id":"Policy term","name":"","label":"Policy term","additional":"","info":"","value":null,"customError":"Please enter a valid Policy term","isRequired":false,"editButton":""},{"type":"text","placeholder":"Please enter any endorsements shown","size":"lg","maxLength":null,"minLength":0,"id":"Endorsements","name":"","label":"Endorsements","additional":"Please list any endorsements shown (these may be in form of hand-writing on the policy or as a small sticker stuck to the document)","info":"","value":null,"customError":"Please enter a valid Endorsements","isRequired":false,"editButton":""},{"type":"textarea","placeholder":"Please enter any additional references","size":"lg","maxLength":null,"minLength":0,"id":"Additional references","name":"Additional references","label":"","additional":"Any additional references detailed on the policy document or correspondence from LV=","info":"","value":null,"customError":"Please enter a valid Additional references","isRequired":false,"editButton":""},{"type":"radio","options":[{"label":"Yes","value":"Yes","selected":false},{"label":"\r\nNo","value":"\r\nNo","selected":false}],"id":"Premium receipt books","name":"Premium receipt books","label":"Premium receipt books","additional":"Have you got any premium receipt books relating to this policy?","info":"","value":"","customError":"Please enter a valid Premium receipt books","isRequired":false,"editButton":""},{"type":"textarea","placeholder":"Please enter any additional comments","size":"lg","maxLength":null,"minLength":0,"id":"Additional comments","name":"Additional comments","label":"","additional":"Please provide any comments that will assist us with tracing any policies and let us know what you would like to do if a policy is found.","info":"","value":null,"customError":"Please enter a valid Additional comments","isRequired":false,"editButton":""},{"type":"checkbox","options":[],"id":"Document","name":"Document","label":"If you have a copy of the original document you can email it to CustomerReconnection@LV.com. 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This includes who we are, how long we hold your information, what we do with it and who we share it with. Please let us know if you'd like us to send you a copy or have any questions.&nbsp;</p></div></div></div></section></div>
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