Critical Illness Insurance UK
Income protection, Permanent Health Insurance, Critical illness, Life Cover,
Mortgage Protection, Family Income Protection

Today is

Your personal quote and information request for critical illness, terminal illness and life cover or any combination of these.
If you do not wish to give private information why not call us (free) 0800 652 8450
or print this page and fax us your details (free) 0800 652 8451

FIELDS MARKED WITH * ARE REQUIRED! >>>> PRIVACY POLICY <<<<

Please indicate the area you live in by giving us your postal /zip code *
*Your name :**
*Date of Birth: :**	(dd/mm/yyyy)
*Smoking :**	Yes No
Name of your partner or 2nd. Person :	Please leave blank for single request
Date of Birth :	(dd/mm/yyyy)
Smoking :	Yes No
Children :	Further children or children in the future: Yes & Maybe
If you have existing insurance it will help us to tailor / profile if you give us as much detail as possible, or ask us to check your existing cover for better benfits :	No Yes please provide some detailsPlease check my existing cover
Purpose / cover :	Adjustable security (CI,TI & LI) Critical & Terminal Illness only Draw an Insurance Profile for me
To give you best first quotes and advice the following information will help us to determine a first profile. Thus avoiding offering policies and sums that are not suitable.
Critical Illness	Lump Sum Payment (10.000, 15000,50.000, 100.000)
Term of cover (length/termination)	Years Age
The next information is not required but will help us to establish your profile for best advice
Terminal Illness	Lump Sum Payment
Permanent Disability	Monthly payment
Life / Mortgage Insurance	Present mortgage (remaining sum)
With these information's we can tailor and advise the best insurance profile for you. Any question please do not hesitate to ask.
Income Protection	Monthly payment (max to 50% present income)
Present income level	(Approximated figure like 15000, 20000 or 40000 etc.)
Do you know your present minimum of cost of living ?	Approximated monthly figure would help us
Do you have private health / medical insurance ? Present performance of the NHS is not improving. Do you want to wait ?
Private Medical Health	by employer existing contract none interested
Please provide employment or self employment as accurate as possible.
Employed	Yes Title/Description :
	If yes please provide period of sickness payment
Self- Employed	Yes Title/Description :

Additional information or any questions :
Please indicate your preferred method of contact There will be no sales call, but providing a telephone number may help us should we have questions regarding your requested cover.	tel.. Best time :
E-mail Address:*	Very important (please check)
Add to Mailing List:	Yes CII may send you updates. No
How did you find us:

Depending on the overall workload we strive to reply 
within two working days.
 
   
Please remember if you do not wish to give private information 
across the Internet why not call us
 (free) 0800 652 8450

 or print this page (portrait) and fax us your details 
(free) 0800 652 8451

Private Medical Insurance

Critical Illness Insurance UK Income protection, Permanent Health Insurance, Critical illness, Life Cover, Mortgage Protection, Family Income Protection

Critical Illness Insurance UK
Income protection, Permanent Health Insurance, Critical illness, Life Cover,
Mortgage Protection, Family Income Protection