| Client
Name |
|
|
| First
Applicant Details |
|
|
| What
is the 1st applicants sex? |
|
|
| What
is the 1st applicants date of birth? |
|
|
(dd/mm/yy) |
|
| Has
the 1st app. smoked in the last 12 months? |
|
|
| Second
Applicant Details |
|
|
| What
is the 2nd applicants sex? |
|
|
| What
is the 2nd applicants date of birth? |
|
|
(dd/mm/yy) |
|
| Has
the 2nd app. smoked in the last 12 months? |
|
|
|
Policy Details
|
|
|
|
|
|
Policy
type |
|
|
| Waiver
of premium |
|
|
|
|
|
|
|
|
|
|
Amount
of life or critical illness cover £ |
|
|
|
|
OR |
|
|
|
|
Premium required £ |
|
|
|
|
|
|
|
|
| Policy
term |
|
years |
|
| Business
Terms
|
|
|
| Reduced
earnings period |
|
|
|
|
|
| |
|
|
| |
