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Get a Quotation

Please complete the form below and we can start working on your quotation we will then contact you with details of the cover you require and the price you are likely to pay

 
First ApplicantSecond Applicant
Title:
Name:

Address:
Postcode:
Email:
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Alternate Number:
Preferred Contact Method:
Best Time to Contact You:
Date of Birth: / / dd/mm/yyyy / / dd/mm/yyyy
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 feet  inches
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Weight:  stones  pounds
Or   kilograms
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Or   kilograms
Do you Smoke?
Basis of Cover (single or joint):
How much Cover do you require?£
Reason for Cover?
Number of years cover is Required?
Level or Decreasing?
Do you have a pre-existing Condition?
Family History of the Serious Medical Condition:
i.e. heart attack, cancer, stroke, etc.
Do you have a Hazardous Occupation or Hobby?
Has any application for Life Insurance been declined, postponed, withdrawn or accepted on special terms (e.g. an increase in premium)?
OR are you awaiting a decision on a current application?
How did you Find Us?

Additional Information:

Notes:
You voluntarily choose to provide personal details to us via this website.  Personal information will be treated as confidential by us and held in accordance with the Data Protection Act 1998.  You agree that such personal information may be used to provide you with details of services and products in writing, by email or by telephone.
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Life Cover For All LLP (Registered in England under company Reg No OC359631) is an Appointed Representative of
Access Wealth Management, The Beacon, Beaufront Park, Anick Road, Hexham, Northumberland, NE46 4TU
which is authorised and regulated by the Financial Conduct Authority

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