Title Select Mr Mrs Miss Ms Dr Other
First Name
Surname
Date Of birth dd 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 mm 01 02 03 04 05 06 07 08 09 10 11 12 yyyy 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Are You A Smoker Smoker Non Smoker If you have smoked or used any tobacco products during the last 12 months then you are classed as being a smoker
Type Of Cover Select - Type Of Cover Life Insurance only Critical Illness cover Life & Critical Illness Life InsuranceWill pay out the amount of money you are insured for should the policy holder die during the term of the policy. Critical Illness CoverA Critical Illness policy will pay out a tax-free lump sum upon diagnosis of a specified critical illness (which are defined by the insurance companies). Life & Critical IllnessA Life and Critical Illness policy is combination of Life Insurance and Critical Illness and will pay out once for either death or diagnosis of a specified critical illness.
Level or Decreasing Select Level Decreasing Level TermLevel term insurance simply means you pay a fixed premium for a fixed number of years and you would receive a full payout on claim at any point. Level cover is ideal for family protection and interest only mortgages. Decreasing TermDecreasing term insurance is a slightly cheaper option than level term. The difference is that the amount of cover reduces on a yearly basis, usually inline with a mortgage or loan, the monthly payments however, remain the same each year.
Amount Of Cover (£) 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 £1,600,000 £1,700,000 £1,800,000 £1,900,000 £2,000,000 £2,100,000 £2,200,000 £2,300,000 £2,400,000 £2,500,000 £2,600,000 £2,700,000 £2,800,000 £2,900,000 £3,000,000 Amount Of CoverThe amount of money you would liked to be insured for. Think about all the things that you or your loved ones would need money for in the event that you died or became terminally ill.
Over What Term (years) Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Term Of PolicyThe term of the policy is the number of years you wish the policy to run for. If the policy term finishes without a claim being made then nothing will be paid. Should a claim be made during the term then the policy will cease after the claim.
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