The fact is – nobody lives forever and should the worse happen or you fall critically ill and cannot work while your family is financially dependent on you, how will they manage? For less than the cost of a few cups of coffee or a couple of pints of beer per month you can have the peace of mind that your loved ones will not be left to struggle should the worst happen.

Complete this form for our UK based staff to access the best deals. It’s totally free and you have no obligation to buy

What type of cover are you looking for?*

How much cover do you need?*

Length of cover required?*

(Years)

Are you a smoker?*

Yes

Premium type?

Level or Decreasing Cover?

Add your partner to the policy?*

Title

First Name*

Surname*

Gender*

Male

Female

Date of birth*

(Must be 18 or older)

Best number to reach you on*

Secondary Phone

E-mail address*

Address*

Address Line 2

City*

Current postcode*

Title

First Name

Last Name

Partner’s Gender

Date of birth

(Must be 18 or older)

Are they a smoker?

Yes

By submitting you agree to speak to a qualified Life Insurance Advisor to help with your requirements