Please fill in the details below
Spouse Details
Please note that the more Potential Payment options, the higher the Monthly Premium will be.
Mortgage Protection:
Life Insurance Policy:
Please choose the amount of cover you would like to be covered for?
Life 1
Life 2
Please note that the higher the Life Amount chosen and the longer the term - the higher the Monthly Premium will be.
The conversion option allows you to extend the term of the policy at any stage in the future without being medically examined again. It is always advised to choose this option.
By choosing this option your cover will increase by 3% per Annum. However your Monthly Premium will simultaneously increase by 3% also.
Life and Serious Illness Cover in 1 policy:
Please choose the amount of Life and Serious Illness cover you would like to be covered for?
Serious Illness Cover Policy only:
Thank you for taking the time to complete this survey. Hit Submit to save your data.