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| Single or Joint |
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Joint cover - If you choose a joint life policy, you are insuring two people,
but the benefit is paid only once - on the death of the first of the two
policyholders.
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| Prepared for
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| E-mail Address |
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| Telephone |
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| Gender
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| Smoker*
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| Date of Birth (dd/mm/yyyy) |
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| Sum Insured ( € )
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| Length of Term ( Years )
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| Premium Frequency
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Monthly - Pay
your premiums monthly by direct debit. This is the most commonly chosen payment
option.
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| Indexed |
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Indexed - Life
insurance in which the premium rate and death benefit both rise annually based
upon the Consumer Price Index.
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| Required Insurance Product |
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Dual Life - This provides cover in the event of either parties death - and in
the event of death of 1 party, cover will continue on the second life insure.
Level - Insurance in which the benefits remain the same over the specified
period.
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| *Non-smoker is someone who has not smoked for
12 months. |
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I have read and
agreed to Terms of Business. |
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