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Type of Insurance
Please Select
Life Insurance only
Life + Critical illness
Amount of cover
Please Select
£20,000
£25,000
£30,000
£35,000
£40,000
£45,000
£50,000
£55,000
£60,000
£65,000
£70,000
£75,000
£80,000
£85,000
£90,000
£95,000
£100,000
£105,000
£110,000
£115,000
£120,000
£125,000
£130,000
£135,000
£140,000
£145,000
£150,000
£155,000
£160,000
£165,000
£170,000
£175,000
£180,000
£185,000
£190,000
£195,000
£200,000
£205,000
£210,000
£215,000
£220,000
£225,000
£230,000
£235,000
£240,000
£245,000
£250,000
£255,000
£260,000
£265,000
£270,000
£275,000
£280,000
£285,000
£290,000
£295,000
£300,000
£325,000
£350,000
£375,000
£400,000
£425,000
£450,000
£475,000
£500,000
£550,000
£600,000
£650,000
£700,000
£750,000
£800,000
£850,000
£900,000
£950,000
£1,000,000
£1,100,000
£1,200,000
£1,300,000
£1,400,000
£1,500,000
Please tell us what is the amount of cover required. This is the
lump sum payment that will be paid to your loved ones
in the event of your death. The lump sum payment is to:
Protect your dependants'
standard of living
Payoff your mortgage
If you are not sure what is the amount of cover required then simply choose an approximate amount. One of the expert life insurance representatives will call you back to discuss your quote. You can then revise the cover amount (if required) and discuss further options.
Cover period?
Please Select
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
13 years
14 years
15 years
16 years
17 years
18 years
19 years
20 years
21 years
22 years
23 years
24 years
25 years
26 years
27 years
28 years
29 years
30 years
31 years
32 years
33 years
34 years
35 years
36 years
37 years
38 years
39 years
40 years
41 years
42 years
43 years
44 years
45 years
46 years
47 years
48 years
49 years
50 years
How Long For ?
Please choose the length of the life insurance plan you require. Normally people choose the number of years remaining on their mortgage or until their children are grown up.
Type of cover
Please Select
Level Cover
Decreasing Cover
LEVEL - Protect Your Family
A lump sum is paid to your loved ones if the policy holder dies or diagnosed as terminally ill. It is also sometimes known as life assurance or term insurance.
DECREASING - Protect Your Mortgage
The amount of cover reduces in line with your outstanding mortgage balance. It is also sometimes known as the mortgage life insurance or mortgage protection insurance.
Is this a joint application?
Please Select
Yes
No
Personal Information
First Name
Title
Miss
Mr
Mrs
Ms
Last Name
Date of birth
YYYY
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
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1982
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1963
1962
1961
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1915
1914
1913
1912
1911
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1906
1905
1904
1903
1902
1901
1900
MM
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
DD
01
02
03
04
05
06
07
08
09
10
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12
13
14
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18
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22
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29
30
31
Do you smoke?
No
Yes
Home phone
Work phone
Mobile Phone
Email address
Address
House N. / Street
House / Flat name
Town
Postcode
Partner Information
App.2: First Name
Title
Miss
Mr
Mrs
Ms
App.2: Last Name
App.2: Date of birth
DD
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
MM
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
YYYY
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
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
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
App.2: Do you smoke?
No
Yes
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