Life Insurance

Quotation Form for S.T.A.R

Please fill in the quotation form below if you would like a quotation for Simplified Term Assurance Rebroke.

Please fill in all the boxes that are applicable to your circumstances.

Personal Details

First Life

Title:
Forename(s):
Surname
Sex:MaleFemale
Smoker:YesNo
Date of Birth:
Age Next Birthday:
Country of Residence:
Personal Tax Rate:

Second Life

Title:
Forename(s):
Surname
Sex:MaleFemale
Smoker:YesNo
Date of Birth:
Age Next Birthday:
Country of Residence:
Personal Tax Rate:

Address for Correspondence:

Product Details

Street:
City or Town:
Region or County:
Postal Code:
Telephone Number:
e-mail address:

Options:
Length of Term:
Premium Frequency:MonthlyAnnual
Premium Type:Guarenteed Rate
Reviewable

Include Increasing Premiums?YesNo Click here for an explanation
Quotation Based on: Sum Assured
Since your application for your existing policy have you:
  • attended any hospital or clinic for any medical investigation or test, or
  • had any medical treatment lasting more than three weeks, or
  • had a positive HIV/AIDS test?

    Life 1 YesNo

    Life 2 YesNo

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    sales@i-insuranceservices.co.uk

    Part of i-Financial Sevrices Group Plc

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