hsbctravel.test.myclaimshub.co.uk
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urlscan Pro
104.21.1.2
Public Scan
URL:
https://hsbctravel.test.myclaimshub.co.uk/
Submission: On September 10 via automatic, source certstream-urgent — Scanned from DE
Submission: On September 10 via automatic, source certstream-urgent — Scanned from DE
Form analysis 1 forms found in the DOM
POST /
<form id="about-you" action="/" method="post" autocomplete="off">
<input type="hidden" name="_csrf" value="uhKmfHmVbk8YBJPh8106re_gUqE5b66wm-Uwlcljs8f3IMcRAcwoKF5x0aCXG1bi2KkKkwkAm4Ku1AXT_Qzylw==">
<div class="grid-x grid-margin-x">
<div class="cell">
<p>Fields marked with <span class="alert-color">*</span> are required</p>
</div>
<div class="form-field cell small-12 field-aboutyou-first_name required">
<div class="grid-x label-group"><label class="control-label" for="aboutyou-first_name">First name</label>
<div class="hint"></div>
</div>
<input type="text" id="aboutyou-first_name" name="AboutYou[first_name]" value="" maxlength="100" autocomplete="off" aria-required="true">
<div class="help-block"></div>
</div>
<div class="form-field cell small-12 field-aboutyou-last_name required">
<div class="grid-x label-group"><label class="control-label" for="aboutyou-last_name">Last name</label>
<div class="hint"></div>
</div>
<input type="text" id="aboutyou-last_name" name="AboutYou[last_name]" value="" maxlength="100" autocomplete="off" aria-required="true">
<div class="help-block"></div>
</div>
<div class="cell small-12">
<div class="grid-x grid-margin-x">
<div class="cell form-field field-aboutyou-date_of_birth">
<div class="grid-x"><label class="cell small-11" for="aboutyou-date_of_birth">Date of birth</label>
<div class="hint cell small-1"></div>
</div>
</div>
<div class="form-field cell small-4 field-aboutyou-birth_day required">
<select id="aboutyou-birth_day" name="AboutYou[birth_day]" autocomplete="off" aria-required="true">
<option value="" selected="">Day:</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
</div>
<div class="form-field cell small-4 field-aboutyou-birth_month required">
<select id="aboutyou-birth_month" name="AboutYou[birth_month]" autocomplete="off" aria-required="true">
<option value="" selected="">Month:</option>
<option value="1">January</option>
<option value="2">February</option>
<option value="3">March</option>
<option value="4">April</option>
<option value="5">May</option>
<option value="6">June</option>
<option value="7">July</option>
<option value="8">August</option>
<option value="9">September</option>
<option value="10">October</option>
<option value="11">November</option>
<option value="12">December</option>
</select>
</div>
<div class="form-field cell small-4 field-aboutyou-birth_year required">
<select id="aboutyou-birth_year" name="AboutYou[birth_year]" autocomplete="off" aria-required="true">
<option value="" selected="">Year:</option>
<option value="2021">2021</option>
<option value="2020">2020</option>
<option value="2019">2019</option>
<option value="2018">2018</option>
<option value="2017">2017</option>
<option value="2016">2016</option>
<option value="2015">2015</option>
<option value="2014">2014</option>
<option value="2013">2013</option>
<option value="2012">2012</option>
<option value="2011">2011</option>
<option value="2010">2010</option>
<option value="2009">2009</option>
<option value="2008">2008</option>
<option value="2007">2007</option>
<option value="2006">2006</option>
<option value="2005">2005</option>
<option value="2004">2004</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
<option value="1969">1969</option>
<option value="1968">1968</option>
<option value="1967">1967</option>
<option value="1966">1966</option>
<option value="1965">1965</option>
<option value="1964">1964</option>
<option value="1963">1963</option>
<option value="1962">1962</option>
<option value="1961">1961</option>
<option value="1960">1960</option>
<option value="1959">1959</option>
<option value="1958">1958</option>
<option value="1957">1957</option>
<option value="1956">1956</option>
<option value="1955">1955</option>
<option value="1954">1954</option>
<option value="1953">1953</option>
<option value="1952">1952</option>
<option value="1951">1951</option>
<option value="1950">1950</option>
<option value="1949">1949</option>
<option value="1948">1948</option>
<option value="1947">1947</option>
<option value="1946">1946</option>
<option value="1945">1945</option>
<option value="1944">1944</option>
<option value="1943">1943</option>
<option value="1942">1942</option>
<option value="1941">1941</option>
<option value="1940">1940</option>
<option value="1939">1939</option>
<option value="1938">1938</option>
<option value="1937">1937</option>
<option value="1936">1936</option>
<option value="1935">1935</option>
<option value="1934">1934</option>
<option value="1933">1933</option>
<option value="1932">1932</option>
<option value="1931">1931</option>
<option value="1930">1930</option>
<option value="1929">1929</option>
<option value="1928">1928</option>
<option value="1927">1927</option>
<option value="1926">1926</option>
<option value="1925">1925</option>
<option value="1924">1924</option>
<option value="1923">1923</option>
<option value="1922">1922</option>
<option value="1921">1921</option>
<option value="1920">1920</option>
<option value="1919">1919</option>
<option value="1918">1918</option>
<option value="1917">1917</option>
<option value="1916">1916</option>
<option value="1915">1915</option>
<option value="1914">1914</option>
<option value="1913">1913</option>
<option value="1912">1912</option>
<option value="1911">1911</option>
<option value="1910">1910</option>
<option value="1909">1909</option>
<option value="1908">1908</option>
<option value="1907">1907</option>
<option value="1906">1906</option>
<option value="1905">1905</option>
<option value="1904">1904</option>
<option value="1903">1903</option>
<option value="1902">1902</option>
<option value="1901">1901</option>
</select>
</div>
<div class="cell error-only field-aboutyou-date_of_birth">
<div class="help-block"></div>
</div>
<div class="cell error-only field-aboutyou-birth_day required">
<div class="help-block"></div>
</div>
<div class="cell error-only field-aboutyou-birth_month required">
<div class="help-block"></div>
</div>
<div class="cell error-only field-aboutyou-birth_year required">
<div class="help-block"></div>
</div>
</div>
</div>
<div class="form-field cell small-12 field-aboutyou-postcode required">
<div class="grid-x label-group"><label class="control-label" for="aboutyou-postcode">Post code</label>
<div class="hint"></div>
</div>
<input type="text" id="aboutyou-postcode" name="AboutYou[postcode]" value="" maxlength="8" autocomplete="off" aria-required="true">
<div class="help-block"></div>
</div>
<div class="form-field cell small-12 field-aboutyou-email_address required">
<div class="grid-x label-group"><label class="control-label" for="aboutyou-email_address">E-mail address</label>
<div class="hint"></div>
</div>
<input type="text" id="aboutyou-email_address" name="AboutYou[email_address]" value="" maxlength="200" autocomplete="off" aria-required="true">
<div class="help-block"></div>
</div>
<div class="form-field cell small-12 field-aboutyou-email_address_check required">
<div class="grid-x label-group"><label class="control-label" for="aboutyou-email_address_check">E-mail address check</label>
<div class="hint"></div>
</div>
<input type="text" id="aboutyou-email_address_check" name="AboutYou[email_address_check]" value="" maxlength="200" autocomplete="off" aria-required="true">
<div class="help-block"></div>
</div>
<div class="form-field cell small-12 field-aboutyou-phone_number required">
<div class="grid-x label-group"><label class="control-label" for="aboutyou-phone_number">Contact phone number</label>
<div class="hint"></div>
</div>
<input type="text" id="aboutyou-phone_number" name="AboutYou[phone_number]" value="" maxlength="20" autocomplete="off" aria-required="true">
<div class="help-block"></div>
</div>
<div class="cell small-12 tar">
<div class="cell form-field field-aboutyou-recaptcha">
<input type="hidden" id="aboutyou-recaptcha" name="AboutYou[reCaptcha]" autocomplete="off">
<div id="aboutyou-recaptcha-recaptcha-about-you" class="g-recaptcha" data-sitekey="6LembzEaAAAAAJfJpGR_9H5ePeRjXbipYN9kOW0Z" data-input-id="aboutyou-recaptcha" data-form-id="about-you">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LembzEaAAAAAJfJpGR_9H5ePeRjXbipYN9kOW0Z&co=aHR0cHM6Ly9oc2JjdHJhdmVsLnRlc3QubXljbGFpbXNodWIuY28udWs6NDQz&hl=en&v=wxAi4AKLXL2kBAvXqI4XLSWS&size=normal&cb=e0y1e7vjwqcj"
width="304" height="78" role="presentation" name="a-r4bst7a5d4or" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div><textarea id="g-recaptcha-response" name="g-recaptcha-response"
class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div>
<div class="help-block"></div>
</div> <button type="submit" class="button" name="next-button">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 Declaration 6 What happens next Fields marked with * are required First name Last name Date of birth Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month: January February March April May June July August September October November December Year: 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 Post code E-mail address E-mail address check Contact phone number Next Privacy Policy | Terms & Conditions Are you sure? Yes No