hsbctravel.uatv2.myclaimshub.co.uk
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https://hsbctravel.uatv2.myclaimshub.co.uk/
Submission: On November 10 via automatic, source certstream-suspicious — Scanned from DE
Submission: On November 10 via automatic, source certstream-suspicious — Scanned from DE
Form analysis 1 forms found in the DOM
<form>
<div class="grid gap-6 grid-cols-1 lg:grid-cols-6">
<div class="lg:col-span-6">
<div class="relative"><label for="9a948fb1-cc7f-44cf-a1b2-62ab69ba0ed0" class="flex w-full justify-between items-center font-medium text-sm text-base-700"><span>First Name<span class="ml-1">*</span></span><span class="field-note"><svg
xmlns="http://www.w3.org/2000/svg" viewBox="0 0 20 20" fill="currentColor" aria-hidden="true" class="w-5 h-5 ml-2">
<path fill-rule="evenodd"
d="M18 10a8 8 0 11-16 0 8 8 0 0116 0zm-7-4a1 1 0 11-2 0 1 1 0 012 0zM9 9a.75.75 0 000 1.5h.253a.25.25 0 01.244.304l-.459 2.066A1.75 1.75 0 0010.747 15H11a.75.75 0 000-1.5h-.253a.25.25 0 01-.244-.304l.459-2.066A1.75 1.75 0 009.253 9H9z"
clip-rule="evenodd"></path>
</svg></span></label><!----></div><input class="field sm:text-sm rounded placeholder:text-base-400 w-full mt-1" type="text" id="9a948fb1-cc7f-44cf-a1b2-62ab69ba0ed0"
placeholder="Please enter your first name exactly as it appears on your policy schedule"><!---->
</div>
<div class="lg:col-span-6">
<div class="relative"><label for="9a948fb1-cc8c-469f-b044-4ff1b3b7560c" class="flex w-full justify-between items-center font-medium text-sm text-base-700"><span>Last Name<span class="ml-1">*</span></span><span class="field-note"><svg
xmlns="http://www.w3.org/2000/svg" viewBox="0 0 20 20" fill="currentColor" aria-hidden="true" class="w-5 h-5 ml-2">
<path fill-rule="evenodd"
d="M18 10a8 8 0 11-16 0 8 8 0 0116 0zm-7-4a1 1 0 11-2 0 1 1 0 012 0zM9 9a.75.75 0 000 1.5h.253a.25.25 0 01.244.304l-.459 2.066A1.75 1.75 0 0010.747 15H11a.75.75 0 000-1.5h-.253a.25.25 0 01-.244-.304l.459-2.066A1.75 1.75 0 009.253 9H9z"
clip-rule="evenodd"></path>
</svg></span></label><!----></div><input class="field sm:text-sm rounded placeholder:text-base-400 w-full mt-1" type="text" id="9a948fb1-cc8c-469f-b044-4ff1b3b7560c"
placeholder="Please enter your last name exactly as it appears on your policy schedule"><!---->
</div>
<div class="lg:col-span-6">
<div class="relative"><label for="9a948fb1-cc97-4eaf-98d9-6b54e7b84c1e" class="flex w-full justify-between items-center font-medium text-sm text-base-700"><span>Date of birth<span class="ml-1">*</span></span><!----></label><!----></div><input
class="field sm:text-sm rounded placeholder:text-base-400 w-full mt-1" type="date" id="9a948fb1-cc97-4eaf-98d9-6b54e7b84c1e"><!---->
</div>
<div class="lg:col-span-6">
<div class="relative"><label for="9a948fb1-cca1-4c01-999d-3ab63bc352e2" class="flex w-full justify-between items-center font-medium text-sm text-base-700"><span>Postcode<span class="ml-1">*</span></span><span class="field-note"><svg
xmlns="http://www.w3.org/2000/svg" viewBox="0 0 20 20" fill="currentColor" aria-hidden="true" class="w-5 h-5 ml-2">
<path fill-rule="evenodd"
d="M18 10a8 8 0 11-16 0 8 8 0 0116 0zm-7-4a1 1 0 11-2 0 1 1 0 012 0zM9 9a.75.75 0 000 1.5h.253a.25.25 0 01.244.304l-.459 2.066A1.75 1.75 0 0010.747 15H11a.75.75 0 000-1.5h-.253a.25.25 0 01-.244-.304l.459-2.066A1.75 1.75 0 009.253 9H9z"
clip-rule="evenodd"></path>
</svg></span></label><!----></div><input class="field sm:text-sm rounded placeholder:text-base-400 w-full mt-1" type="text" id="9a948fb1-cca1-4c01-999d-3ab63bc352e2"><!---->
</div>
<div class="lg:col-span-6">
<div class="relative"><label for="9a948fb1-ccab-4490-b70c-420fa7b569ab" class="flex w-full justify-between items-center font-medium text-sm text-base-700"><span>Email address<span class="ml-1">*</span></span><span class="field-note"><svg
xmlns="http://www.w3.org/2000/svg" viewBox="0 0 20 20" fill="currentColor" aria-hidden="true" class="w-5 h-5 ml-2">
<path fill-rule="evenodd"
d="M18 10a8 8 0 11-16 0 8 8 0 0116 0zm-7-4a1 1 0 11-2 0 1 1 0 012 0zM9 9a.75.75 0 000 1.5h.253a.25.25 0 01.244.304l-.459 2.066A1.75 1.75 0 0010.747 15H11a.75.75 0 000-1.5h-.253a.25.25 0 01-.244-.304l.459-2.066A1.75 1.75 0 009.253 9H9z"
clip-rule="evenodd"></path>
</svg></span></label><!----></div><input class="field sm:text-sm rounded placeholder:text-base-400 w-full mt-1" type="email" id="9a948fb1-ccab-4490-b70c-420fa7b569ab"><!---->
</div>
<div class="lg:col-span-6">
<div class="relative"><label for="9a948fb1-ccb5-4d4c-bee4-e12b3bc5eda0" class="flex w-full justify-between items-center font-medium text-sm text-base-700"><span>Confirm Email address<span class="ml-1">*</span></span><span
class="field-note"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 20 20" fill="currentColor" aria-hidden="true" class="w-5 h-5 ml-2">
<path fill-rule="evenodd"
d="M18 10a8 8 0 11-16 0 8 8 0 0116 0zm-7-4a1 1 0 11-2 0 1 1 0 012 0zM9 9a.75.75 0 000 1.5h.253a.25.25 0 01.244.304l-.459 2.066A1.75 1.75 0 0010.747 15H11a.75.75 0 000-1.5h-.253a.25.25 0 01-.244-.304l.459-2.066A1.75 1.75 0 009.253 9H9z"
clip-rule="evenodd"></path>
</svg></span></label><!----></div><input class="field sm:text-sm rounded placeholder:text-base-400 w-full mt-1" type="email" id="9a948fb1-ccb5-4d4c-bee4-e12b3bc5eda0"><!---->
</div>
<div class="lg:col-span-6">
<div class="relative"><label for="9a948fb1-ccbf-44d6-9cf3-14f7ff773b73" class="flex w-full justify-between items-center font-medium text-sm text-base-700"><span>Contact phone number<span class="ml-1">*</span></span><!----></label><!----></div>
<input class="field sm:text-sm rounded placeholder:text-base-400 w-full mt-1" type="tel" id="9a948fb1-ccbf-44d6-9cf3-14f7ff773b73"><!---->
</div>
<div class="lg:col-span-6">
<div class="inline-flex relative pr-6 mt-1"><!----><!---->
<div id="hcap-script"><iframe
src="https://newassets.hcaptcha.com/captcha/v1/3073b34/static/hcaptcha.html#frame=checkbox&id=0bl0vj5yh0q7&host=hsbctravel.uatv2.myclaimshub.co.uk&sentry=true&reportapi=https%3A%2F%2Faccounts.hcaptcha.com&recaptchacompat=true&custom=false&hl=en&tplinks=on&pstissuer=https%3A%2F%2Fpst-issuer.hcaptcha.com&sitekey=27b07d7a-6c3a-43d6-a11d-913d9d086f53&theme=light&origin=https%3A%2F%2Fhsbctravel.uatv2.myclaimshub.co.uk"
tabindex="0" frameborder="0" scrolling="no" allow="private-state-token-issuance 'src'; private-state-token-redemption 'src'" title="Widget containing checkbox for hCaptcha security challenge" data-hcaptcha-widget-id="0bl0vj5yh0q7"
data-hcaptcha-response="" style="width: 303px; height: 78px; overflow: hidden;"></iframe><textarea id="g-recaptcha-response-0bl0vj5yh0q7" name="g-recaptcha-response" style="display: none;"></textarea><textarea
id="h-captcha-response-0bl0vj5yh0q7" name="h-captcha-response" style="display: none;"></textarea></div>
</div><!---->
</div>
</div>
<div class="my-6 py-6 border-t border-base-200 flex justify-between">
<div></div>
<div><button class="inline-flex primary button" type="submit"> Next </button></div>
</div>
</form>Text Content
Your Travel Insurance Claim
Please tell us about yourself
1.
About you
2.
About your trip
3.
Who is claiming
4.
What happened
5.
Bank details
6.
Declaration
Please tell us about you and your policy. If you have a single trip or annual
travel insurance policy, please enter the name, date of birth and postcode of
someone insured on the policy.
First Name*
Last Name*
Date of birth*
Postcode*
Email address*
Confirm Email address*
Contact phone number*
Next
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