Member Support Request Form

Application form

Find out how we use your personal information and what rights you have by reading How LV= use your personal information. 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.

By completing this application I am aware that my data may be used in line with the LV= ‘How we use your information statement’ which includes being;

  • Used to seek references and information such as are required to verify this application for Member Support.
  • Held for 5 years to assist when reviewing any subsequent request for support.
  • Shared with appointed agents chosen by LV= to enable LV= to support my Member Support application.

Important information

The LV= Members Support is designed to help LV= members who are going through a hard time and need a helping hand.

It is also possible for LV= members to ask for support for one of their family who is having a tough time. To apply you must have been a member of LV= for a continuous period of 12 months. This means you will have held a member qualifying product* with LV= for at least a year.

  • A panel will look at requests and decide if LV= can help and to what degree.
  • The panel’s decision is final and we cannot explain the reason for any decisions.
  • Help might be in the form of a cheque, vouchers, a piece of equipment or something else.
  • To aid in the panel’s work please fill in as much information as you can.
  • If we need more information we might get in touch with you by phone or email so it is important that you give us your contact details.
  • We will aim to make our decision as quickly as possible, and within 21 days.
  • You should only request support once, as repeat requests may be denied.

* Member qualifying products are usually long-term policies such as savings, investment, protection or retirement policies.

Apply for support

Once you’ve completed the form below it’ll be submitted straight to the Member Support Team at LV=.

Who is the grant for?

Who is the grant for?

Part 1 of 7
You can apply to the Members Support for yourself (as a member of LV=) or one of your immediate family. This could include a spouse, partner, parent, child or grandchild.
About you

About you

Part 2 of 7
Line 1
Line 2
Line 3
Line 4
Household income

Household income

Part 3 of 7
Total monthly income from employment
Medical information

Medical information

Part 4 of 7
How we can help you

How we can help you

Part 5 of 7
Upload

Upload

Part 6 of 7
Declaration

Declaration

Part 7 of 7
Name