Critical illness form

Fields marked with an asterisk * are required

Are you filling out this form for you or on behalf of another person?

For me
On behalf of another person

What type of Vodafone account do you have?

What type of Vodafone account do they have?

Select account type: *

Your details

Their details

First name:*

Last name:*

Vodafone account number:

Date of birth:*

Email:*

Phone number:*

How would you like us to contact you?*

How would they like us to contact them?*

Email
Phone

Postcode:

Enter manually

What do you want to do with your mobile account?*

What do they want to do with the mobile account?*

Close account
Change to Pay as you go plan
Transfer the Pay monthly account to another account

What do you want to do with your broadband account?*

What do they want to do with the broadband account?*

Close account
Transfer to another account

Please add any further details about the account changes you want to make (optional)

Please add any further details about the account changes they want to make (optional)

Proof of illness

We need proof of critical illness, mental health conditions, or care home residency.

Proof of critical illness
Proof of mental health condition
Proof of care home residency

Please attach a scan or clear photo of a letter signed by a medical professional. This needs to be on headed paper and dated within the last 6-12 months. Please attach a scan or clear photo of a letter signed by a medical professional confirming that the customer has been sectioned and hospitalised under the Mental Health Act. This needs to be on headed paper and dated within the last 6-12 months. Please attach a scan or clear photo of a letter from the care home confirming residency. This needs to be on headed paper and dated within the last 6-12 months.

Add a file

Please add any further information related to your condition that you’d like us to be aware of (optional)

Please add any further information related to their condition that they’d like us to be aware of (optional)

Please provide your contact details

First name:*

Last name:*

Your mobile number:*

Your email:*

Date of birth:*

How would you like us to contact you?*

Email
Phone