diff --git a/src/layouts/bailout-page/bailout-page.vue b/src/layouts/bailout-page/bailout-page.vue
index a84f0dfe..3c430d64 100644
--- a/src/layouts/bailout-page/bailout-page.vue
+++ b/src/layouts/bailout-page/bailout-page.vue
@@ -20,24 +20,29 @@
                         :subContentProperty="subContentProperty"
                         class="sub-header-content mt-2 mb-5"
                         justification="left" />
-                    <textboxQuestion
-                        ref="firstName"
-                        v-model="bailoutPageModel.firstName"
-                        class="mb-3"
-                        inputId="firstNameField"
-                        cmsWidgetName="FirstNameQuestion"
-                        isRequired
-                        disableAutoFill
-                        :validationRules="rules.firstName" />
-                    <textboxQuestion
-                        ref="lastName"
-                        v-model="bailoutPageModel.lastName"
-                        class="mb-3"
-                        inputId="lastNameField"
-                        cmsWidgetName="LastNameQuestion"
-                        isRequired
-                        disableAutoFill
-                        :validationRules="rules.lastName" />
+                    <div class="row">
+                        <div class="col">
+                            <textboxQuestion
+                                ref="firstName"
+                                v-model="bailoutPageModel.firstName"
+                                inputId="firstNameField"
+                                cmsWidgetName="FirstNameQuestion"
+                                isRequired
+                                disableAutoFill
+                                :validationRules="rules.firstName" />
+                        </div>
+                        <div class="col">
+                            <textboxQuestion
+                                ref="lastName"
+                                v-model="bailoutPageModel.lastName"
+                                class="mb-3"
+                                inputId="lastNameField"
+                                cmsWidgetName="LastNameQuestion"
+                                isRequired
+                                disableAutoFill
+                                :validationRules="rules.lastName" />
+                        </div>
+                    </div>
                     <textboxQuestion
                         ref="phoneNumber"
                         v-model="bailoutPageModel.phoneNumber"
@@ -65,6 +70,10 @@
                         :isBackButtonHidden="!canNavigateBack"
                         @backClicked="backButtonAction"
                         @ForwardClicked="forwardButtonAction" />
+                    <textBlock
+                        class="mt-5 mb-5"
+                        cmsWidgetName="DisclaimerWidget"
+                        typeStyle="caption" />
                 </div>
             </div>
         </div>
@@ -77,6 +86,7 @@ import siteHeader from '@/iss-components/site-header/site-header.vue';
 import siteSubHeader from '@/iss-components/site-sub-header/site-sub-header.vue';
 import siteFooter from '@/iss-components/site-footer/site-footer.vue';
 import textboxQuestion from '@/digital-components/textbox-question/textbox-question.vue';
+import textBlock from '@/digital-components/text-block/text-block.vue';
 // Supporting files
 import BaseFormMixin from '@/mixins/base-form-mixin.js';
 import { fetchCmsContentForPage } from '@/helpers/cms-content-helper';
@@ -99,7 +109,8 @@ export default {
         siteFooter,
         textboxQuestion,
         // eslint-disable-next-line vue/no-reserved-component-names
-        Form
+        Form,
+        textBlock
     },
     mixins: [BaseFormMixin],
     async beforeRouteEnter(to, from, next) {
@@ -130,7 +141,8 @@ export default {
             widget: {
                 defaultSiteHeader: 'SiteSubHeaderWidget',
                 noTpa: 'ContentGroupNoTPAWidget',
-                notSeeingPreferredShop: 'ContentGroupNotSeeingPreferredShop'
+                notSeeingPreferredShop: 'ContentGroupNotSeeingPreferredShop',
+                disclaimerText: 'DisclaimerWidget'
             },
             rules: {
                 firstName: globalRules.FIRST_NAME_REQUIRED,