Income Protection Insurance Quote

General information all questions must be answered to submit an enquiry.

Please complete the form below and we will recommend the most appropriate plan from our panel.

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Please enter a contact telephone number:

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Time:

Underwriting information this will help us recommend the most appropriate policy.

	What is your occupation?:
	In which industry do you work?:
	How many hours per week do you work?:
	Are you aware of anything that may result in you becoming unemployed?:	Yes No
	Has your employer made anyone redundant in the last 12 months? - If yes please add details below:	Yes No

	How long have you been in continuous employment?:	YearsMonths
	How long have you been in your current employment?:	YearsMonths

Please provide the following information so that we can provide you with the most competitive quote.

	Please advise your gross monthly income:
	Monthly Mortgage Payment:
	Monthly Rental Payment:
	Monthly HP / Loans Payments:
	Additional regular monthly outgoings you wish to cover:
	Total monthly benefit required:

Quote Information.

	Please indicate whether you would prefer an excess or waiting period?:
	Please select the benefit period you require?:
	Please advise what type of cover you require?:

Additional information will help us recommend the most appropriate policy.

	Do you have any existing plans of this type?:	Yes No
	If so do you intend to cancel these?:	Yes No

Please use this space to provide us with any additional information that you think is relevant.

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Date of birth is required as some of our policies are age related.

Please enter the telephone number as one continuous number with no spaces. E.g. 01325363392.

We require your occupation as some of our policies are occupationally underwritten.

You cannot apply for any of our policies if you work less than 16 hours per week.

Failure to disclose anything in relation to this will mean any subsequent claim is declined.

A number of policies have a minimum continuous employment requirement.

Generally the maximum benefit available from any combination of plans is restricted to 75% of your gross income.

The Excess period is the period of each claim that you do not qualify for any benefit. The most common excess period is 30 days this means you do not start accruing benefit until you have been unemployed or disabled for 30 days.

Back to day one policies are policies that do not have an excess instead they have a waiting period. Once you have been unemployed or disabled for 30 days benefit is back dated to day one. However if you are unemployed or disabled for less than 30 days you do not qualify for any benefit

Any existing plans must be disclosed to your insurer failure to do so could invalidate your policy.