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Application form

To activate your cover and registration under the GoldShield Scheme please complete the form below or alternatively download a printable version. A copy of your home purchase invoice will also be required, within 90 days of purchasing your park home.

A late application fee will be applicable if this is received after the 90 day period has expired.

Details of your Park Home

Manufacturer

Manufacturer’s Serial Number

Model and Size

Date of Manufacture

The Park Owner

Company Name

Address Post Code

Daytime Telephone Number

Park registration number

The Home Owner

Full Name

Address Post Code

Daytime Telephone Number

Email Address

Date of Completion of First Purchase

Day

Month

Year