Your details
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Confirmation
Your policy details
What do you need the insurance to protect?
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Mortgage

Insurance which pays a sum of money which can be used to repay a mortgage (or loan) if you die during the term of the policy.

Living Costs

Insurance which pays a guaranteed and fixed sum of money if you die during the term of the policy which can be used to provide for living expenses or any other purposes.

Mortgage and Living costs

Insurance which pays a guaranteed and fixed sum of money if you die during the term of the policy which can be used to repay a mortgage (or loan) and any other purposes including covering future living expenses.

What type of mortgage do you have?
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Interest only (level)

With an interest only (level) mortgage the sum of money outstanding remains the same throughout the period of the mortgage and therefore the policy quoted will be a level term life insurance where the amount that is paid out if you die within the term of the policy stays the same. It provides certainty as both the cover and premiums are fixed from the date you start paying the premiums until the end of the policy term.

Repayment (decreasing)

With a capital repayment (decreasing) mortgage the sum of money outstanding reduces over time. Therefore the policy quoted is a decreasing life insurance policy where the sum of money paid out if you die within the term of the policy also reduces over the term of the policy.

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Amount of cover (also called total sum assured). This is the value that would be paid; For Level policies, the event of death (or diagnosis of terminal or specified critical illness if included). For Decreasing policies, the initial amount to cover your mortgage in the event of death (or diagnosis of terminal or specified critical illness if included). This amount decreases during the term and is designed to meet the outstanding amount of your mortgage at any point during the term.

£
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You choose how long you want your policy to last. Think about the age of any children who depend on you financially or the time left on unprotected loan payments. If you're protecting your mortgage, consider the number of years left until your mortgage ends.

Who is the policy for?
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You choose whether this policy is just to cover yourself or whether you would like to take out a joint application to cover both your life and someone else's life, such as a partner's life.

If you take out a joint application the policy will only pay out once when the first person dies (or diagnosis of terminal or specified critical illness if included) and meets our definition during the length of the policy.

,
About You
Title

Date of birth

Please provide your email address in order that we can confirm your quotation in writing.

We may contact you to assist with your Life insurance quotation. Please provide your telephone number if you consent to us calling you to discuss.

What is your height?
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Please enter your height (without shoes)

ft
ins
What is your weight?
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Please enter your weight (wearing indoor clothes)

st
lbs
Lifestyle
Please select an answer
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A smoker is someone who has smoked any cigarettes, cigars, a pipe, used e-cigarettes (whether or not they contain nicotine), or used nicotine replacements at all in the last 12 months.

Please tell us when you stopped smoking
Help

If you have smoked any cigarettes, cigars, a pipe, used e-cigarettes (whether or not they contain nicotine), or used nicotine replacements at all in the last 12 months you are classified as a smoker

per day
years
During a typical week, how many alcoholic drinks do you have?
Help

For example, a drink is a glass of wine or a glass or bottle of beer.

What is your trouser size in UK inches?
Help

Please use the size from the most recent clothing purchase you made for yourself.

What is your dress, skirt or trouser size?
Help

Please use the size from the most recent clothing purchase you made for yourself. If you're pregnant, please advise your size prior to this pregnancy.

During the last 2 years, have you seen a health professional about:
  • a blood condition for example anaemia, blood clot?
  • a lung or breathing condition for example asthma, bronchitis, chronic obstructive lung disease, emphysema. Please ignore hay fever and isolated chest infections from which you have fully recovered?
  • a condition affecting your stomach, bowel or oesophagus for example Crohn's disease, ulcerative colitis. Please ignore diarrhoea, food poisoning, sickness or vomiting, stomach bug or upset provided you have fully recovered?
  • any type of arthritis or gout?
  • a growth, lump, polyp or tumour?
  • anxiety, depression or any other type of mental illness?
  • any other condition for which you are required to attend review or follow-up, including medication review, or a condition for which you have been admitted overnight to hospital. Please ignore accidents and injuries from which you have fully recovered?
During the last 2 years, have you seen a health professional about:
  • a blood condition for example anaemia, blood clot?
  • a lung or breathing condition for example asthma, bronchitis, chronic obstructive lung disease, emphysema. Please ignore hay fever and isolated chest infections from which you have fully recovered?
  • a condition affecting your stomach, bowel or oesophagus for example Crohn's disease, ulcerative colitis. Please ignore diarrhoea, food poisoning, sickness or vomiting, stomach bug or upset provided you have fully recovered?
  • any type of arthritis or gout?
  • a growth, lump, polyp or tumour?
  • anxiety, depression or any other type of mental illness?
  • any other condition for which you are required to attend review or follow-up, including medication review, or a condition for which you have been admitted overnight to hospital. Please ignore accidents and injuries from which you have fully recovered or pregnancy, contraceptive and infertility medication?
Have any of your natural parents, brothers or sisters, before the age of 60, had any of the following?
  • Alzheimer's disease or dementia
  • Cancer of the bowel (colon), breast or ovary
  • Cardiomyopathy
  • Heart attack, diabetes or stroke
  • Huntington's disease
  • Motor neurone disease
  • Multiple sclerosis
  • Myotonic Dystrophy
  • Parkinson's disease
  • Polycystic kidney disease
  • Any other condition that runs in your family and that you're receiving regular follow up or screening for
  • Don't know
In the last 30 days have you:
  • had a new or unexplained continuous cough, fever or high temperature, loss of smell or taste?
  • tested positive for or been diagnosed with coronavirus/COVID-19?
Have you ever:
  • had diabetes, excess sugar in the blood or a heart condition for example angina, heart attack, heart valve problem, heart surgery?
  • had a stroke, transient ischaemic attack (TIA) or a brain haemorrhage?
  • had cancer, Hodgkin's disease, Non-Hodgkin's lymphoma, leukaemia, a melanoma or a brain tumour?
  • had a neurological condition for example cerebral palsy, epilepsy, motor neurone disease, multiple sclerosis, muscular dystrophy, optic neuritis, paralysis, Parkinson's disease
  • been admitted overnight to hospital or referred to a psychiatrist for mental illness, anorexia or bulimia?
  • tested positive for HIV, or are you waiting for the result of an HIV test?
During the last 5 years, have you seen a health professional about:
Help

Please ignore birthmarks where no treatment or specialist referral has been advised.

  • raised blood pressure?
  • raised cholesterol?
  • a condition affecting your kidney, bladder, liver or pancreas for example kidney stones, hepatitis, fatty liver?
  • chest pain, palpitations or irregular heartbeat, numbness, persistent tingling or pins and needles, memory loss, dizziness, balance problems, lupus, tremor or facial pain other than dental pain?
  • a mole or freckle?
  • any condition affecting your ears or hearing (for example Meniere's disease or deafness), or eyes or vision not wholly corrected by spectacles, lenses or laser treatment, (for example cataract, blindness)?
During the last 5 years, have you seen a health professional about:
Help

Please ignore routine cervical smears if the results have been normal. Please ignore birthmarks where no treatment or specialist referral has been advised.

  • raised blood pressure?
  • raised cholesterol?
  • a condition affecting your kidney, bladder, liver or pancreas for example kidney stones, hepatitis, fatty liver?
  • chest pain, palpitations or irregular heartbeat, numbness, persistent tingling or pins and needles, memory loss, dizziness, balance problems, lupus, tremor or facial pain other than dental pain?
  • a mole or freckle?
  • any condition affecting your ears or hearing (for example Meniere's disease or deafness), or eyes or vision not wholly corrected by spectacles, lenses or laser treatment, (for example cataract, blindness)?
  • any gynaecological condition for which you've not yet been discharged from follow up, or a cervical smear requiring further investigations?
During the last 3 months, have you had:
  • unexplained bleeding, weight loss, lump or growth?
  • breast or testicular changes of any sort?
  • a mole or freckle that has bled or changed in appearance or any other changes to your skin?
  • any other symptom for which you may see a health professional about for the first time?
Do you regularly take part in any of the following activities for work or recreation?
Help

You can ignore one off parachute jumps

  • Flying (other than as a fare-paying passenger)
  • Hang gliding or paragliding
  • Motor car or motorcycle sport
  • Mountaineering or rock climbing
  • Parachuting, sky diving or BASE jumping
  • Underwater diving
  • Any other extreme sport
During the last 2 years have you spent more than 90 consecutive days in Africa, the Caribbean, Russia, Thailand or Ukraine?
During the next 2 years do you intend to spend more than 30 consecutive days outside the UK, EU, USA, Canada, Australia or New Zealand ?
Help

You can ignore travel as a member of the Armed Forces

Do you work outside at heights over 15 metres (50ft), offshore in the oil, gas or fishing industry, in the Armed Forces or as a member of the army reserve
During the last 5 years have you been disqualified from driving for a motoring offence or convicted of careless or reckless driving?
During the last 5 years have you used any of the following?
Help

We'll only use the answer to this question to assess your application and at claim stage. Therefore there are no 'legal implications' in answering yes to this question.

  • Recreational drugs, for example cocaine, ecstasy, heroin
  • Methadone
  • Anabolic steroids not prescribed by a doctor
Have you ever been:
  • told by a health professional that you should reduce the amount of alcohol you have because you were drinking too much?
  • seen by an alcohol specialist or attended an alcohol support group or been told that you have any liver damage?
Including this application, what is the total amount of life and critical illness cover you will have?
Help

Please include any applications being made to another insurer but ignore cover that will be cancelled if this policy goes ahead.

,
About other applicant
Title

Date of birth

What is your height?
Help

Please enter your height (without shoes)

ft
ins
What is your weight?
Help

Please enter your weight (wearing indoor clothes)

st
lbs
Lifestyle
Please select an answer
Help

A smoker is someone who has smoked any cigarettes, cigars, a pipe, used e-cigarettes (whether or not they contain nicotine), or used nicotine replacements at all in the last 12 months.

Please tell us when you stopped smoking
Help

If you have smoked any cigarettes, cigars, a pipe, used e-cigarettes (whether or not they contain nicotine), or used nicotine replacements at all in the last 12 months you are classified as a smoker

per day
years
During a typical week, how many alcoholic drinks do you have?
Help

For example, a drink is a glass of wine or a glass or bottle of beer.

What is your trouser size in UK inches?
Help

Please use the size from the most recent clothing purchase you made for yourself.

What is your dress, skirt or trouser size?
Help

Please use the size from the most recent clothing purchase you made for yourself. If you're pregnant, please advise your size prior to this pregnancy.

During the last 2 years, have you seen a health professional about:
  • a blood condition for example anaemia, blood clot?
  • a lung or breathing condition for example asthma, bronchitis, chronic obstructive lung disease, emphysema. Please ignore hay fever and isolated chest infections from which you have fully recovered?
  • a condition affecting your stomach, bowel or oesophagus for example Crohn's disease, ulcerative colitis. Please ignore diarrhoea, food poisoning, sickness or vomiting, stomach bug or upset provided you have fully recovered?
  • any type of arthritis or gout?
  • a growth, lump, polyp or tumour?
  • anxiety, depression or any other type of mental illness?
  • any other condition for which you are required to attend review or follow-up, including medication review, or a condition for which you have been admitted overnight to hospital. Please ignore accidents and injuries from which you have fully recovered?
During the last 2 years, have you seen a health professional about:
  • a blood condition for example anaemia, blood clot?
  • a lung or breathing condition for example asthma, bronchitis, chronic obstructive lung disease, emphysema. Please ignore hay fever and isolated chest infections from which you have fully recovered?
  • a condition affecting your stomach, bowel or oesophagus for example Crohn's disease, ulcerative colitis. Please ignore diarrhoea, food poisoning, sickness or vomiting, stomach bug or upset provided you have fully recovered?
  • any type of arthritis or gout?
  • a growth, lump, polyp or tumour?
  • anxiety, depression or any other type of mental illness?
  • any other condition for which you are required to attend review or follow-up, including medication review, or a condition for which you have been admitted overnight to hospital. Please ignore accidents and injuries from which you have fully recovered or pregnancy, contraceptive and infertility medication?
Have any of your natural parents, brothers or sisters, before the age of 60, had any of the following?
  • Alzheimer's disease or dementia
  • Cancer of the bowel (colon), breast or ovary
  • Cardiomyopathy
  • Heart attack, diabetes or stroke
  • Huntington's disease
  • Motor neurone disease
  • Multiple sclerosis
  • Myotonic Dystrophy
  • Parkinson's disease
  • Polycystic kidney disease
  • Any other condition that runs in your family and that you're receiving regular follow up or screening for
  • Don't know
In the last 30 days have you:
  • had a new or unexplained continuous cough, fever or high temperature, loss of smell or taste?
  • tested positive for or been diagnosed with coronavirus/COVID-19?
Have you ever:
  • had diabetes, excess sugar in the blood or a heart condition for example angina, heart attack, heart valve problem, heart surgery?
  • had a stroke, transient ischaemic attack (TIA) or a brain haemorrhage?
  • had cancer, Hodgkin's disease, Non-Hodgkin's lymphoma, leukaemia, a melanoma or a brain tumour?
  • had a neurological condition for example cerebral palsy, epilepsy, motor neurone disease, multiple sclerosis, muscular dystrophy, optic neuritis, paralysis, Parkinson's disease
  • been admitted overnight to hospital or referred to a psychiatrist for mental illness, anorexia or bulimia?
  • tested positive for HIV, or are you waiting for the result of an HIV test?
During the last 5 years, have you seen a health professional about:
Help

Please ignore birthmarks where no treatment or specialist referral has been advised.

  • raised blood pressure?
  • raised cholesterol?
  • a condition affecting your kidney, bladder, liver or pancreas for example kidney stones, hepatitis, fatty liver?
  • chest pain, palpitations or irregular heartbeat, numbness, persistent tingling or pins and needles, memory loss, dizziness, balance problems, lupus, tremor or facial pain other than dental pain?
  • a mole or freckle?
  • any condition affecting your ears or hearing (for example Meniere's disease or deafness), or eyes or vision not wholly corrected by spectacles, lenses or laser treatment, (for example cataract, blindness)?
During the last 5 years, have you seen a health professional about:
Help

Please ignore routine cervical smears if the results have been normal. Please ignore birthmarks where no treatment or specialist referral has been advised.

  • raised blood pressure?
  • raised cholesterol?
  • a condition affecting your kidney, bladder, liver or pancreas for example kidney stones, hepatitis, fatty liver?
  • chest pain, palpitations or irregular heartbeat, numbness, persistent tingling or pins and needles, memory loss, dizziness, balance problems, lupus, tremor or facial pain other than dental pain?
  • a mole or freckle?
  • any condition affecting your ears or hearing (for example Meniere's disease or deafness), or eyes or vision not wholly corrected by spectacles, lenses or laser treatment, (for example cataract, blindness)?
  • any gynaecological condition for which you've not yet been discharged from follow up, or a cervical smear requiring further investigations?
During the last 3 months, have you had:
  • unexplained bleeding, weight loss, lump or growth?
  • breast or testicular changes of any sort?
  • a mole or freckle that has bled or changed in appearance or any other changes to your skin?
  • any other symptom for which you may see a health professional about for the first time?
Do you regularly take part in any of the following activities for work or recreation?
Help

You can ignore one off parachute jumps

  • Flying (other than as a fare-paying passenger)
  • Hang gliding or paragliding
  • Motor car or motorcycle sport
  • Mountaineering or rock climbing
  • Parachuting, sky diving or BASE jumping
  • Underwater diving
  • Any other extreme sport
During the last 2 years have you spent more than 90 consecutive days in Africa, the Caribbean, Russia, Thailand or Ukraine?
During the next 2 years do you intend to spend more than 30 consecutive days outside the UK, EU, USA, Canada, Australia or New Zealand ?
Help

You can ignore travel as a member of the Armed Forces

Do you work outside at heights over 15 metres (50ft), offshore in the oil, gas or fishing industry, in the Armed Forces or as a member of the army reserve
During the last 5 years have you been disqualified from driving for a motoring offence or convicted of careless or reckless driving?
During the last 5 years have you used any of the following?
Help

We'll only use the answer to this question to assess your application and at claim stage. Therefore there are no 'legal implications' in answering yes to this question.

  • Recreational drugs, for example cocaine, ecstasy, heroin
  • Methadone
  • Anabolic steroids not prescribed by a doctor
Have you ever been:
  • told by a health professional that you should reduce the amount of alcohol you have because you were drinking too much?
  • seen by an alcohol specialist or attended an alcohol support group or been told that you have any liver damage?
Including this application, what is the total amount of life and critical illness cover you will have?
Help

Please include any applications being made to another insurer but ignore cover that will be cancelled if this policy goes ahead.

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