Cover · free template

Policy Change Request

Two-page mid-term change request: which policy, what is changing and from when, the details behind the change and how any adjustment is settled.

A ready-to-use insurance form for small teams who need a reliable intake process: 20 questions, 2 pages, 4 conditional rules.

Questions
20
Pages
2
Layouts
classic · card
Time to complete
≈ 5 min
Conditional rules
4
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Live preview and test console

This is the real form. Answer it to test the flow — nothing is sent or stored.

Page 1 of 2 — Policy and change type

Which policy is changing

Include your country code.

Are you the policyholder?

This template runs as a straight sequence — no branching rules.

Compliance checklist

Ready to publish
  • Payment items priced — passingEvery payment question charges a real amount, so a submission always records a payment.
  • Conditional logic resolves — passingEvery rule points at a question or page that exists in this template.
  • Financial disclaimer present — passingThis form does not provide financial, tax or legal advice. Any figures shown are indicative only and are not an offer of credit or a guarantee of terms. Please seek advice from a regulated adviser before making a decision.
  • Question labels unique — passingLogic and exports address questions by label, so duplicates are ambiguous.

What happens after submit: nothing is stored in this preview. On your own copy, every response triggers an instant email notification and lands in your response dashboard, ready to export or forward.

Happy with it? Take a copy into your workspace — every question, rule and setting comes with it.

Who this template is for

Policy Change Request is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.

  • Small teams who need a reliable intake process working in insurance.
  • Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
  • Anyone replacing chasing missing details over email with one structured record per enquiry.
  • Respondents are the people you send it to — the form asks them 20 questions across 2 screens.
  • Mobile-heavy audiences, thanks to the one-question-per-screen card layout.

Why this form is useful

It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.

  • 9 questions are required, so submissions arrive complete instead of needing a follow-up email.
  • It collects a verified email address so replies and confirmations land.
  • It captures a phone number for urgent follow-up.
  • It accepts a document or photo upload as evidence.
  • It pins the request to a specific date.
  • It captures a full postal address.
  • It allows multiple selections without free text.
  • Conditional logic hides 4 questions until they are relevant — shorter forms convert better than long ones.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

  1. 1Press “Use this template” — a fresh copy of Policy Change Request lands in your workspace, ready to edit.
  2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
  3. 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
  4. 4Check the upload limits on the file question so respondents can attach what you actually need.
  5. 5Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
  6. 6Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 4 conditional rules ship with it.

  • Features conditional validation: if “What would you like to change?” is Add or remove a named driver, “Driver name, date of birth and licence details” becomes mandatory before the form can be sent.
  • Features conditional validation: if “What would you like to change?” is Change of address, “New address” becomes mandatory before the form can be sent.
  • Features conditional validation: if “What would you like to change?” is Cancel the policy, “Why are you cancelling?” becomes mandatory before the form can be sent.
  • Features conditional validation: if “Are you the policyholder?” is No, I am acting for them, “Your name and your authority to act” becomes mandatory before the form can be sent.
  • All 4 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.

About this template

Mid-term changes are simple individually and chaotic in aggregate, because each type needs different information and most forms ask for all of it. This two-page request asks what type of change is wanted first, then only the fields that change needs. The first page identifies the policy and the person asking, confirms they are the policyholder or authorised to act, and records the change type: address, vehicle, named driver, cover level, business details, payment details, or cancellation. The second page holds the detail sections, shown according to that answer — new address and date of the move, vehicle registration and keeper, driver details and licence history, new cover level or sum insured, updated turnover or staff numbers. Every change asks for an effective date, because a change backdated by guesswork is where disputes start. The last section covers how any additional premium or refund is handled. Whether a change can be made, and what it costs, is decided by the insurer against the policy terms rather than confirmed here.

What this form asks

Every question is editable — rename it, make it optional, or delete it entirely.

Page 1 — Policy and change type

  • Policy numberrequired
  • Policyholder namerequired
  • Contact numberrequired
  • Email addressrequired
  • Are you the policyholder?required
  • Your name and your authority to act
  • What would you like to change?required
  • From what date should the change apply?required

Page 2 — Details of the change

  • New address
  • Date of the move
  • New vehicle registration, make and model
  • Registered keeper of the new vehicle
  • Driver name, date of birth and licence details
  • New level of cover or sum insured
  • Updated business details
  • Why are you cancelling?
  • How should any difference be settled?required
  • Anything else we should know?
  • Upload any document that supports the change
  • Confirmationrequired

20 questions in total.

Example of a completed policy change request form

This sample shows how a policyholder requests an address change on their policy.

Policy number
POL-882316
Policyholder name
Simon Achebe
Are you the policyholder?
Yes
What would you like to change?
My address
From what date should the change apply?
1 June 2026
New address
14 Birchwood Avenue, Cardiff, CF5 3RT
Date of the move
28 May 2026
Anything else we should know?
No

Sample data — no real people, addresses or records are shown.

How the form changes as it's filled in

This template ships with 4 conditional rules, grouped into 4 behaviours driven by 2 questions. Everything below is already set up — edit or delete any rule once the template is in your workspace.

Driven by “What would you like to change?”

  • Makes answers required

    If “What would you like to change?” is Add or remove a named driver, “Driver name, date of birth and licence details” becomes required before the form can be submitted.

  • Makes answers required

    If “What would you like to change?” is Change of address, “New address” becomes required before the form can be submitted.

  • Makes answers required

    If “What would you like to change?” is Cancel the policy, “Why are you cancelling?” becomes required before the form can be submitted.

Driven by “Are you the policyholder?”

  • Makes answers required

    If “Are you the policyholder?” is No, I am acting for them, “Your name and your authority to act” becomes required before the form can be submitted.

Set it up step by step

  1. 1

    Ask for the change type first

    One question at the top lets the second page show four fields instead of thirty, which is the difference between a two-minute form and an abandoned one.

  2. 2

    Always require an effective date

    Backdating by assumption is where most mid-term disputes begin, so make the date explicit and confirm it in writing.

  3. 3

    Route cancellations to a person

    A cancellation request is a retention conversation as much as an administrative one, so it should not be processed silently.

  4. 4

    Confirm the premium effect separately

    The settlement question captures a preference; the actual figure comes from the insurer and belongs in your confirmation.

Mistakes to avoid

  • Showing every change section to everyone, so the form looks like an application.
  • Quoting the cost of a change in the form, before the insurer has rated it.
  • Letting a customer assume a change is live on submission, which the confirmation checkbox is there to prevent.

What it pairs with

Most teams don't run this form on its own. These are the forms and systems it sits next to.

What to do with the responses

Confirm the change and any premium adjustment in writing, update the policy record from the effective date, and route cancellations to a named handler.

Works in both layouts

Browse classic templatesBrowse card templates

Forms that overlap this one

These pages cover the same subject ground as the policy change request, matched on the words people actually search for.

Frequently asked questions

Is the change effective when the form is submitted?

No. The confirmation makes that explicit: a change applies once the insurer confirms it, and your written confirmation is what the customer should rely on.

How does it relate to the quote request?

The Insurance Quote Request Form is for new cover. This form adjusts a policy that already exists, which needs the policy number and an effective date.

Can a broker complete it for a client?

Yes. The authority question captures who is asking and on what basis, which is worth recording even when the relationship is obvious.

Should the form show the cost of the change?

No. Pricing a mid-term adjustment is the insurer's, so capture the preference for settling any difference and confirm the figure afterwards.

Is the Policy Change Request template free to use?

Yes. You can preview and test Policy Change Request on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.

What does the Policy Change Request template ask for?

It asks 20 questions across 2 pages, 9 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.

Can I edit the Policy Change Request form after copying it?

Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.

How does the conditional logic in this insurance form work?

4 conditional rules ship with the template: Features conditional validation: if “What would you like to change?” is Add or remove a named driver, “Driver name, date of birth and licence details” becomes mandatory before the form can be sent. Features conditional validation: if “What would you like to change?” is Change of address, “New address” becomes mandatory before the form can be sent. Features conditional validation: if “What would you like to change?” is Cancel the policy, “Why are you cancelling?” becomes mandatory before the form can be sent. All rules are editable in the Logic tab.

Where do responses to the Policy Change Request form go?

Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.

Can I embed the Policy Change Request form on my own website?

Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.

Can respondents upload files?

Yes. This template includes a file upload question, so respondents can attach documents or photos with their answers. You can adjust the accepted file types and size limits on that question.

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