On-line services for Quoteme4

Protection Quotation Form
Client Details
Clients
Life A Life B
Sex
Date of Birth (dd/mm/yyyy)
Smoker ?
Occupation
Please enter your occupation, or a search term 
(E.g. Butcher, Baker, Candlestick Maker)

Phone
May we contact you by Phone?
Email
Product Options
Product Type
Benefit Type
In the event of a Critical Illness claim :
Please select up to 3 critical illness/total permanent disability options.
If no options are selected you will receive the providers' chosen default
Clear All View Critical Illness Coverage
Premium (£)
Annual Death Benefit Amount(£)
Annual CI Benefit Amount(£)
Do you want a Renewable policy?
What renewable term would you like?
Term  Years
Premium Frequency
Mortgage Interest Rate
Note: Some providers may not use this value.
Increasing Benefit?
Waiver of Premium?
Provides premium payments on your behalf, in
event of long term ill health or incapacity.
Rates
How did you hear about us?

Please ensure that you read the quote and key features document to ensure that this policy meets your protection requirements as you have not obtained advice as to the suitability of this plan to meet your protection needs.

If you have any problems completing or sending this form, please e-mail us, or call 0800 0226571.

Please read these Important Notes carefully when filling out the on-line Form.

  1. Please answer the questions as accurately as possible.
  2. We can only provide your Quotation on the basis that you are in Good Health. If this is not the case, then please contact our office to discuss your situation.
  3. If you wish for a Single Life to be quoted, enter one set of details. For Joint Lives, select the 'Joint' option and complete both sections.
  4. Tell us about the Type of Cover that you want. Enter a figure for the term (the period for which insurance is required) in whole years, and the amount of cover needed (in Pounds). We currently provide quotations for Term Assurance - other products will follow soon.
  5. Press the Get Quote button - then wait a few seconds for Your Quotation to be processed and returned to you On-Line.
  1. You will then be invited to give your name and e-mail address. Click 'proceed' and the system will generate a Personalised Illustration and key features document which should always be read. These documents are delivered in 'pdf' format (please note that it takes a few seconds for this to download to your machine. If the screen appears blank, then press 'refresh').
  2. You may then download a Proposal form (also in pdf formats). Please complete the printed proposal, and mail it back to your selected Financial Intermediary - their address will be shown at the end of the form.
  3. Please note that this offer does not represent personalised advice and is not a recommendation that this product, level of cover or provider selected matches your financial requirement. If you should have any doubts about whether this product meets your own needs, please contact us so that your individual circumstances can be considered.

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