The application form is available in PDF format and requires Acrobat Reader for viewing. Please send the completed application form to:

Grosvenor Trust & Savings (for CCBA)
10-12 Lawn Lane,
Hemel Hempstead,
Herts HP3 9HH

To download the application form , click below and save to disk:

BUPA Application Form

To get a free copy of Adobe's Acrobat Reader, click below:

For more information
To find out more about the benefits BUPA membership provides
or to receive a quotation follow the links above or phone

01442 347850 †

Alternatively e-mail info@ccba.org.uk stating your name, the ages of the people you wish to be covered and a contact number.

Discounts only apply to BUPACare and BUPA Local HospitalCare and relate to current standard BUPACare and Local HospitalCare subscription rates. They are available to those joining between 01/01/2008 and 30/06/2008. They may not be combined with any other discounts that you may be eligible for. BUPA reserves the right to alter or withdraw the discount on or after your first renewal date and the right to vary payments during a contract year if the rate of Insurance Premium Tax changes. Terms and conditions of BUPA group schemes may differ from those of BUPA personal schemes.

Membership is subject to acceptance by BUPA and the rules and benefits of the scheme you apply for including exclusions, restrictions and any other special conditions that may apply. Precise terms of cover will depend on assessment of your individual circumstances. Full details are available on request and will be sent to you when you join.

Cover is provided by BUPA Insurance Limited, a BUPA Group company and wholly owned subsidiary of the British United Provident Association Limited.

† Calls to this number will be answered by Grosvenor Trust & Savings on behalf of the Computer Contractors Benefit Association who are independent of BUPA and do not act as its agent. BUPA does not accept any responsibility for advice given by Grosvenor Trust & Savings. Grosvenor Trust & Savings is the trading name of A+ Financial Services Ltd which is authorised and regulated by the Financial Services Authority.