<% 'Create the variables for the sidebars, page id and quotemsg Dim pID, subpID, quoteMsg 'Current page id pID = 5 'Message in the header, leave blank for no quote quoteMsg = "" dim sAnimal sAnimal = "DOG" Dim strAddressList Dim strAddressNewList Dim strPostCode dim sField dim straddressListComma dim iCnt1 Dim iYear 'Dim strURL if requestForm("txtAddressFlag") = "0" then if not(requestForm("txtOldPostArea")) = "" then for each sField in Request.form select case sField case "" case else if session(sField) = cstr(simplyRequest(sField)) then else session(sField) = cstr(simplyRequest(sField)) end if end select next End if elseif requestForm("txtAddressFlag") = "1" then If not(requestForm("txtNewPostArea")) = "" then for each sField in Request.form select case sField case "" case else if session(sField) = cstr(simplyRequest(sField)) then else session(sField) = cstr(simplyRequest(sField)) end if end select next End if End if Dim strCampaignPlan strCampaignPlan = CheckCampaignPlan() Dim pvdiscount pvdiscount= availDiscount() %> <% 'Retrive Dog & Cat breed list from MSDE DB dim oRSBreedListDog dim oRSBreedListCat dim oRSBreedListRab set ahBreedList = server.CreateObject("AC_AH_PREMIUM.cGetPremium") '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 'Retrive Dog breed list from MSDE DB set oRSBreedListDog = server.createobject("ADODB.recordset") set oRSBreedListDog = ahBreedList.GetBreedList(cstr("dog"),cstr("PP")) oRSBreedListDog.MoveFirst 'Retrive Cat breed list from MSDE DB set oRSBreedListCat = server.createobject("ADODB.recordset") set oRSBreedListCat = ahBreedList.GetBreedList(cstr("cat"),cstr("PP")) oRSBreedListCat.MoveFirst 'Retrive Rabbit breed list from MSDE DB set oRSBreedListRab = server.createobject("ADODB.recordset") set oRSBreedListRab = ahBreedList.GetBreedList(cstr("rab"),cstr("PP")) set ahBreedList = nothing oRSBreedListRab.MoveFirst %>

Your details

Request a summary of the claims we have received and processed on your pet's policy. The summary will include the Claim number, paid or rejected, conditions claimed, treatment dates, amounts claimed, amounts deducted, amounts paid, and payee name.

All fields marked * are mandatory

There are some problems with your submission, please check the form below for errors and try again.
" type='text' data-parsley-generictextminimallettersonly="" title='Please enter your First Name' placeholder='Enter your first name' maxlength='30' data-parsley-required='true' aria-required='true' />
" data-parsley-generictextminimallettersonly="" data-parsley-required='true' aria-required='true' title='Please enter your Last Name' placeholder='Enter your last name' maxlength='30' data-parsley-required='true' aria-required='true' />
Date of Birth *
" type='text' data-parsley-generictextminimalnumberslettersonly='' title='Please enter your Postcode and click "Find Address"' placeholder='Your postcode' maxlength='10' data-parsley-required='true' aria-required='true' />
" />
" type='text' title='Please enter your House name/no' data-parsley-generictext="" placeholder='Enter your House name/no' maxlength='100' data-parsley-required='true' aria-required='true' /> " />
" type='text' title='Please enter your Street' data-parsley-generictext="" placeholder='Enter your Street' maxlength='100' data-parsley-required='true' aria-required='true' />
" type='text' title='Please enter your Town' data-parsley-generictext="" placeholder='Enter your Town' maxlength='100' data-parsley-required='true' aria-required='true' />
" type='text' title='Please enter your County' data-parsley-generictext="" placeholder='Enter your County' maxlength='100' />
" type='text' data-parsley-policyno="" title='Please enter your Policy number' placeholder='Enter Policy number' maxlength='9' data-parsley-required='true' aria-required='true' />  " type='text' data-parsley-policyno="" title='Please enter your Policy number' placeholder='Enter Policy number' maxlength='9' class="hidden" data-parsley-required='true' aria-required='true' />  " type='text' data-parsley-policyno="" title='Please enter your Policy number' placeholder='Enter Policy number' maxlength='9' class="hidden" data-parsley-required='true' aria-required='true' />  " type='text' data-parsley-policyno="" title='Please enter your Policy number' placeholder='Enter Policy number' maxlength='9' class="hidden" data-parsley-required='true' aria-required='true' />  " type='text' data-parsley-policyno="" title='Please enter your Policy number' placeholder='Enter Policy number' maxlength='9' class="hidden" data-parsley-required='true' aria-required='true' />  " type='text' data-parsley-policyno="" title='Please enter your Policy number' placeholder='Enter Policy number' maxlength='9' class="hidden" data-parsley-required='true' aria-required='true' /> 
Your policy number is 9 digits long and can be found on your Certificate of Insurance.
If you have a number of policies with Petplan, please provide all your policy numbers.
" data-parsley-generictextminimallettersonly='' title='Please enter your Pets Name' placeholder='Enter pet name' maxlength='100' data-parsley-required='true' aria-required='true' />