Protection - Quick Quote

Which type of benefit are you interested in?

Reason for cover

Level of Cover Required (sum assured) 🛈

Policy Term 🛈

Monthly Budget *

APPLICANT 1

Full Name *

Date of Birth * +

Gender *

Male

Female

Address *

Status *

Owner/Occupier

Renting

Living with family

Mobile number *

Email address *

Occupation *

Annual Salary / Taxable Income *

Monthly Income *

Monthly Expenses * 🛈

Disposable Income

£0

What is your height?

Are you a smoker? *

Yes

How many cigarettes a day?

Do you drink alcohol?

Yes

Average daily number of drinks?

Within the last 5 years have you:

Had any form of medical treatment or taken any prescribed treatment?

Yes

Attended or been advised to attend hospital or clinic either as an inpatient or outpatient?

Yes

Seen a doctor or been counselled for anxiety, depression or any other mental or nervous illness?

Yes

Apart from any medical conditions you've already told us about, are you:

Currently intending to seek any medical advice?

Yes

Currently undergoing or awaiting medical investigations or tests?

Yes

Particpating any hazardous sports or activities?

Yes

Have any of your natural parents, brothers or sisters been diagnosed as having the below conditions:

Angina, a heart attack, stroke, bowel cancer, colon cancer, breast or ovarian cancer, Huntington's disease, polycystic kidney disease or any inherited condition before they were 65.

If yes, please provide details

APPLICANT 2

Full Name

Date of Birth +

Gender

Male

Female

Address

Status