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.

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