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Policy Type
Are you looking for a single or joint policy?
Single
Joint
Applicant 1
Sex
Please Select
Female
Male
Date Of Birth
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Month
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Year
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Are you a smoker?
For insurance purposes, you will be considered a smoker if you have smoked or used any nicotine replacement products in the last 12 months.
Please Select
No
Yes
Title
First Name
Surname
Applicant 2
Sex
Please Select
Female
Male
Date Of Birth
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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22
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24
25
26
27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
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1975
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1972
1971
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1964
1963
1962
1961
1960
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1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
Are you a smoker?
For insurance purposes, you will be considered a smoker if you have smoked or used any nicotine replacement products in the last 12 months.
Please Select
No
Yes
Title
First Name
Surname
Cover Requirements
Type of cover required?
Select the type of insurance to suit your needs:
-
Level Term Insurance
will provide a fixed sum over the term of the policy. In the event of a claim being made the payout will be the amount insured.
-
Decreasing Term Insurance
is specifically designed to protect against a ‘repayment’ (capital/interest) mortgage, therefore the sum assured will reduce inline with your mortgage.
Please Select
Level Term Insurance
Decreasing Term Insurance
Benefit options?
Select the conditions that you would like the policy to pay out under.
-
Life Cover Only
pays out in the event of death within the term of the policy.
-
Critical Illness Only
pays out on diagnosis of a predefined illness. Insurers cover between 26 & 37 illnesses which are listed in each Insurers Key Features Document, shown on the next page.
-
Life Insurance and Critical Illness
will cover both eventualities & will normally pay out on the first event. Please ask us for more information.
Please Select
Life Insurance Only
Critical Illness Only
Life Insurance and Critical Illness
Amount of cover?
Enter the amount of cover in GBP's (£'s) that you require
Term of policy (years)?
Enter the number of years you would like the policy to run for.
Your Details
Email Address
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Telephone Number
Address Line 1
Postcode
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