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About First Applicant

About Applicant 1 (About You)

Title

First name

Surname

What is your name

Why do we need to know this?

To ensure your quotation is valid for you and to save you time should you wish to apply.

Date of birth

Why do we need to know this?

Because the quotation is calculated on your exact date of birth, not just age.

Please take reasonable care to answer all the questions honestly and to the best of your knowledge. If you don’t, your policy may be cancelled, or treated as if it never existed, or your claim rejected or not fully paid.

Have you smoked in the last 12 months?

Why do we need to know this?

Because premiums are based on your smoking status. A smoker is someone who in the last 12 months uses cigarettes, cigars, pipe tobacco, chewing tobacco, any nicotine replacement products (for example chewing gums or patches), shisha pipes or electronic cigarettes.

Please take reasonable care to answer all the questions honestly and to the best of your knowledge. If you don’t, your policy may be cancelled, or treated as if it never existed, or your claim rejected or not fully paid.

Policy details

Policy details

Policy Type

Level term life insurance

  • If you die during the policy term your insurer will pay the full amount of cover

Level term life & critical illness insurance

  • If you die or are diagnosed with a specified critical illness during the term your insurer will pay the amount you are covered for.

Mortgage protection life insurance

  • The amount of cover reduces to cover the balance on a repayment mortgage.
  • If you die during the term your insurer will pay the calculated amount of cover at that time.

Mortgage protection life & critical illness

  • The amount of cover reduces to cover the balance on a repayment mortgage.
  • If you die or are diagnosed with a specified critical illness during the term your insurer will pay the amount you are covered for.

Sum assured?

What do I do?

Enter the amount of cover that you require in the event of a claim during the policy term.

Policy term

What do I do?

Enter the number of years you would like the insurance to last for.

Additional details

Additional details

Contact Number

We'd like your phone number so we can give you a call about your quote. We won’t pressure you into buying anything and you won’t be contacted for any other reason.

 

You may receive periodic contact from Columbus Direct and other companies within The Collinson Group via email or post, with information on selected products, services, free offers, discounts and relevant news.

You can choose not to receive these communications by ticking this box.

Life insurance

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