Let's get started by understanding a bit more about you.

What's your first name ? *

What's your last name? *

What's your date of birth? *

What stage are you in your search? *

Do you currently have any income protection? *

Yes

Unsure

What is your current living situation? *

Renting, Homeowner with a mortgage, Buying a house soon, etc.

How much do you pay towards your rent each month? *

What type of mortgage do you have? *

How long do you have left to run on your mortgage? *

How much do you have left to pay on your mortgage? *

How much do you pay towards the mortgage each month? *

Is the mortgage just in your name or joint names? *

My Name

Joint Names

How many years will your new mortgage run for? *

What type of mortgage are you taking out? *

Will the mortgage just be in your name or joint names? *

My Name

Joint Names

How much are you going to borrow in total? *

How much will it cost you each month? *

Income protection protects you if you can't work due to sickness or an accident or injury. Let's run through what you do for a living

What's your employment status? *

What do you do for a living? *

How much do you take home each month after tax etc? *

Do you get any sick pay from work? *

Yes

No Sure

Your insurance needs!

Tell us what you need your policy to do

How much money do you need each month to make sure your bills are paid? *

You can choose how long you want to wait for before the policy starts paying out. (Waiting Period)

If you have sick pay or savings to fall back on you can choose to wait longer and the monthly cost would be less

How long would you be able to wait before the policy stars paying out? (choose the options you want quotes for) *

Insurers will let you choose how long you can claim for if you are off work.
You can cover yourself until you retire or put a limit on such as 1, 2 or 5 years per claim which makes the policy cheaper

I'd like to be able to claim for *

1 year, 2 years, 5 years, no limit

Are any of these additional benefits of interest?

(Tick all that apply) *

Fracture Cover - This gives you an extra payout for things like broken bones

Virtual GP services & prescription services

Health checks

Mental health & bereavement support

Access to worldwide Doctors & Second Opinions

Children's cover

Reward systems for keeping fit

None of the above

If you are off work due to an accident injury or sickness, insurers will check your medical records so its vital to provide accurate information

How tall are you? *

How much do you weigh? *

Have you smoked or used any nicotine replacement products in the last 12 months? *

Yes

Have you been registered with a UK GP for more than 2 years? *

Yes

Are you a UK Resident ? *

Yes

Have you every had any of the following conditions (Select all that apply) *

Have any of your natural parents brother or sisters suffered from any cancer, heart attack, stroke, diabetes or MS? *

Have you seen a Doctor or specialist for any medical condition in the last 5 years? *

Yes

You can ignore things like common colds or flu

Do you have any medical results pending or check-ups due? *

Yes

Have you taken any medication, got advice or had treatment for any condition in the last 12 months? *

Yes

Have you had any back issues in the last 12 months ? *

Yes

Have you had any Mental Health issues in the last 5 years? *

Yes

Thanks for completing your profile!

We'll review your information and get back to you with the best options?

What is the best time to contact you? *

Anytime

Mornings before 12 noon

Afternoons 12 until 5pm

After 5pm

Phone (including SMS) *

Email *

I agree that I have read and understand the Privacy Policy and agree for my information to be used to provide a quotation.