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This plan is designed to meet the needs of people who are looking for life insurance with guaranteed acceptance that pays out a lump sum when they die. If this plan meets your needs please continue. The following questions must only be answered by the person to be insured.

The plan you are applying for is designed to meet the needs of people who are looking for a guaranteed acceptance life insurance plan to pay a cash sum upon death. If this plan meets your needs please continue with the application. The following questions must only be answered by the person to be insured and they must be resident in England, Wales, Scotland or Northern Ireland.

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Why do you need this plan?Why do you need this plan? This will help us give you relevant product information. (select all that apply)

We ask this question so we can understand why our customers are applying for this product and to allow us to present the most relevant information suited to their needs. Please tick all options that apply

Your date of birthHelp - More info - Date of Birth

You must be between the ages of 50 and 80, a UK resident and have spent at least 183 days in the UK in the last tax year.

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In the last 12 months have you used tobacco, e-cigarettes or nicotine replacement products?

'Yes, Regularly' means more than once a week.
'Yes, Occasionally' means once a week or less.

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Enter your address

Please complete the following information to help us find your address

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Please provide your street name

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We're here to help - If you would like help understanding the product call us on
0800 107 0047. We're happy to call you back if you prefer - leave your telephone number below and one of our friendly team in Cardiff will be in touch.

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Your email address:Help - More info - Email Address
• Don’t worry, we will not use it for marketing material without your permission.
• We will send you a copy of your quote.
• We need this should you decide that you want to apply.

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We’d love to email you personalised information about your quote and exclusive offers on our products and services.
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