Please take reasonable care to answer all the questions honestly and to the best of your knowledge. If you don't answer the questions correctly, your policy may be cancelled, or your claim rejected or not fully paid.
Cover type
Single
Joint
Date from which cover is to start
Day
Month
Year
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
01
02
03
04
05
06
07
08
09
10
11
12
2020
2019
2018
2017
Proposers Personal Information
Title
Mr
Mrs
Miss
Ms
Dr
Rev
Other
Forename(s)
Surname
Day
Month
Year
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
01
02
03
04
05
06
07
08
09
10
11
12
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
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
What is your email address
By supplying data you are agreeing to our
Terms of Business
and our
Privacy Security Policy
Telephone number
Risk Address Postcode
Address
Employment type
Employed
Self Employed
Contract Worker
1) Are you now and have you been for the past 6 months in continuous employment?
Yes
No
2) Do you know of any impending unemployment which may affect you?
Yes
No
3) Have you been resident in the UK, channel islands or Isle Man for the past 6 months?
Yes
No
Partners Personal Information
Partner's Date of Birth
Day
Month
Year
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
01
02
03
04
05
06
07
08
09
10
11
12
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
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
Employment type
Employed
Self Employed
Contract Worker
1) Are you now and have you been for the past 6 months in continuous employment?
Yes
No
2) Do you know of any impending unemployment which may affect you?
Yes
No
3) Have you been resident in the UK, channel islands or Isle Man for the past 6 months?
Yes
No
Client Salary Information
Proposer's Annual Salary
Partner's Annual Salary
Your safeguard calculator
(Amount of monthly outgoings)
Mortgage / Rent
HP / Loans / Credit Cards
Gas / Electricity / Water
Insurances / Council Tax
Education Fees
Other Expenses
Monthly benefit required:
Your cover options -
for help and more information click here
1) How many days would you like before your policy starts to pay for accident and sickness cover
When you have an accident or become sick you maybe entitled to sick pay from your employer for a certain amount of days, this can reduce your premium amount so check your contract. If you have no entitlement for sick pay then choose back to day one.
Back To day one
30 day
60 day
90 day
2) How many days would you like before your policy starts to pay when you are unemployed
Back To day one
30 day
60 day
90 day
If you have any problems please call
01608 647601
with your reference
1932130569613
You can also recall your quote at a later date if you keep note of your email and reference
Terms of business
Authorised and regulated by the Financial Conduct Authority 307824