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Life Insurance

1. 1. Your Details
2. 2. Get Quotes
3. 3. Apply

Your Personal Details

Is this a single or a joint policy?

Single Joint

Forename

Surname

Date of birth 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 January February March April May June July August September October November December 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

Sex

MaleFemale

Have you smoked in the last 12 months?

YesNo

 

Your Partners Details

Forename

Surname

Date of birth 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 January February March April May June July August September October November December 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

Sex

MaleFemale

Have you smoked in the last 12 months?

YesNo

Cover Required

Type of cover? Level Term Life & Critical Illness Insurance Level Term life Insurance Decreasing Term Life & Critical Illness Decreasing Term Life Insurance Decreasing Term Critical Illness Insurance Level Critical Illness Insurance Decreasing Critical Illness Insurance

How long do you need cover for? (years) 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

How much cover do you need? (£) £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

Your Contact Details

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Mobile Telephone

Email address

Home Telephone

Postcode

Work Telephone

Enter address manually

Address

Town

County

Postcode

Information you give to us will allow us to obtain the right life assurance policy for your needs. Whether you want just your mortgage protected, or for business or family protection, we will search the market for the precise product to fulfill all of your requirements.

 

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Life Assurance from The Mortgage Shop

The Mortgage Shop is a trading style of Mortgage Shop No1 Limited which is an appointed representative of Personal Touch Financial Services Limited which is authorised and regulated by the Financial Services Authority. The Mortgage Shop is entered on the FSA register (http://fsa.gov.uk) under reference 425677. Buy to let mortgages may not be regulated by the FSA & personal loans are not regulated by the FSA. The guidance and/or advice within this website is subject to the UK regulatory regime and is therefore targeted at consumers based in the UK.

THINK CAREFULLY BEFORE SECURING OTHER DEBTS AGAINST YOUR HOME.
YOUR HOME MAY BE REPOSSESSED IF YOU DO NOT KEEP UP REPAYMENTS ON YOUR MORTGAGE.

There will be a fee for mortgage advice of £299. Telephone calls may be recorded for training purposes.