SHARE

For low cost life cover & critical illness

Complete and submit the questionnaire below and we will provide you with an illustrative quote for level term assurance cover. All quotations are subject to the completion of a proposal form and satisfactory acceptance by the provider. Cover will not be in force until confirmed by the provider and the first premiuim paid.

Sole/First Applicant Details








Male
Female


Yes
No





£

Yes
No

* Required

Second Applicant Details






Male
Female


Yes
No