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Life Insurance

Who do you require a quote for?

myself    myself and my partner 
 
Your Title
 
Your First Name(s)
 
Your Surname
 
Address
 
Post code
 
Daytime Phone
 
And/or Evening Phone
 
And/or Mobile Phone
 
Your Email Address
 
Are you? male      female
 
 
Have you smoked any tobacco products in the last twelve months?
yes        no
 
 
 
 
Your date of birth?  
DAY       MONTH       YEAR
 

 
Quote :  
 
How long do you want to be covered? years
 
How much cover do you require? in ús
 
Would you like to pay?  
monthly  annually
 
 
If the cover is to protect a mortgage debt, is the mortgage a "repayment" version?
yes        no
 
 
yes         no
 
 
Would you like a quotation for critical illness cover? (Critical illness cover pays out on diagnosis of a serious illness)
yes         no
 
 
What is your occupation?
 
Comments
 

 

 

 
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NOTICE –The contents of this website should not be construed as financial advice, if in doubt always seek professional advice and always read the policy documents before entering into an insurance contract, to ensure it meets your needs. Please see our full terms and conditions. This website is owned and operated by NISEM Limited, company registration number NI070215. NISEM Limited are authorised and regulated by the Financial Services Authority (FSA), registration number 502872.