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Policy Type
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Life insurance

You choose the amount of cover you want. If you die during the policy term your insurer will pay the amount you are covered for. The policy usually stops when a claim has been paid. These policies have no-cash in value at any time.

Mortgage life insurance

You choose the amount of cover you want and the amount of cover reduces each month during the policy term and is calculated to be enough to equal the capital outstanding under a normal repayment mortgage. If you die during the policy term your insurer will pay the calculated amount of cover at that time. The policy usually stops when a claim has been paid. These policies have no cash in value at any time.

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You choose how long you want your policy to last. Think about the age of any children who depend on you financially or the time left on unprotected loan payments. If you're protecting your mortgage, consider the number of years left until your mortgage ends.

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Amount of cover (also called total sum assured). This is the value that would be paid; For Level policies, the event of death (or diagnosis of terminal or specified critical illness if included). For Decreasing policies, the initial amount to cover your mortgage in the event of death (or diagnosis of terminal or specified critical illness if included). This amount decreases during the term and is designed to meet the outstanding amount of your mortgage at any point during the term.

£
Who is the policy for?
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You choose whether this policy is just to cover yourself or whether you would like to take out a joint application to cover both your life and someone else's life, such as a partner's life.

If you take out a joint application the policy will only pay out once when the first person dies (or diagnosis of terminal or specified critical illness if included) and meets our definition during the length of the policy.

,
About You
Title

Date of birth

What is your height?
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Please enter your height (without shoes)

ft
ins
What is your weight?
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Please enter your weight (wearing indoor clothes)

st
lbs
Lifestyle
Please select an answer
Help

A smoker is someone who has smoked any cigarettes, cigars, a pipe, used e-cigarettes (whether or not they contain nicotine), or used nicotine replacements at all in the last 12 months.

Please tell us when you stopped smoking
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If you have smoked any cigarettes, cigars, a pipe, used e-cigarettes (whether or not they contain nicotine), or used nicotine replacements at all in the last 12 months you are classified as a smoker

per day
years
Units of alcohol per week?
Help

Please enter the approximate units of alcohol consumed per week over the last or a typical month. A glass of wine (250ml) is 2.9 units, pint of ordinary strength beer 2 units, strong/premium beer or cider 3 units or single measure/shot of spirits or bottles of alcopops 1.5 units

Within the last 5 years have you:
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You need to disclose if you have had treatment during the last 5 years from a doctor, nurse, psychiatrist, or counsellor as well as any regular ongoing treatment for conditions such as asthma and raised blood pressure. You do not need to disclose hay fever or outpatient-only treatment for injuries or sprains

  • had any form of medical treatment or taken any prescribed treatment?
  • attended or been advised to attend hospital or clinic either as an inpatient or outpatient?
  • seen a doctor or been counselled for anxiety, depression or any other mental or nervous illness?
Are you currently taking any prescribed medication? (ignoring medication related to colds, flu, hay fever, pregnancy, back or knee pain, fractures, HRT)
Have any of your natural parents, brothers or sisters been diagnosed as having angina, a heart attack, stroke, bowel cancer, colon cancer, breast or ovarian cancer, Huntington's disease, polycystic kidney disease or any inherited condition before they were 65?
Help

By 'inherited condition' , we mean one or any of: Alports syndrome, Alzheimer's disease or dementia, Diabetes, Dysplastic naevus syndrome, Familial Adenomatous Polyposis of the colon (FAP), Familial Hypercholesterolaemia, Haemochromatosis, Hypertrophic Obstructive Cardiomyopathy (HOCM), Motor Neurone Disease, Multiple Sclerosis, Muscular Dystrophy, Parkinson's disease, Porphyria, Sub arachnoid haemorrhage or TIA, Tuberous sclerosis. If you're adopted or estranged from your family and do not know their medical history you can respond no to this question.

Have you been diagnosed with, received any treatment, or been referred for investigation or tests, for:
Help

This includes any such diagnosis, treatment, referral or investigation/test you have ever had for these conditions.

  • chest pain, a heart attack, or any other heart condition?
  • a stroke or transient ischaemic attack (TIA, a minor form of stroke)?
  • brain haemorrhage or brain injury?
  • diabetes?
  • cancer, leukaemia, Hodgkin's disease, lymphoma or any other form of tumour?
Have you been diagnosed with, received any treatment, or been referred for investigation or tests, for:
Help

This includes any such diagnosis, treatment, referral or investigation/test you have ever had for these conditions.

  • kidney failure?
  • paralysis?
  • multiple sclerosis?
  • blurred or double vision?
  • loss of feeling, numbness or pins and needles serious enough to have been reported to a doctor?
Apart from any medical conditions you've already told us about, are you:
Help

You need to disclose if you have any current or recent symptoms you have experienced which are being investigated, about to be treated or for which you are intending to see a doctor, nurse, psychiatrist, or counsellor. You do not need to disclose such symptoms if you are planning to see or be treated by a chiropodist, chiropractor, dentist, osteopath or physiotherapist.

  • currently intending to seek any medical advice?
  • currently undergoing or awaiting medical investigations or tests?
  • waiting for any form of treatment to start?
Have you ever tested positive for HIV/AIDS or hepatitis B or C, or are you awaiting the results of such a test? (If the result of a test you're waiting for turns out to be negative, the fact that you had a test won't affect the acceptance terms the provider offers you.)
Do you take part in any of the following activities:
Help

Extreme sports include activities such as advanced competitive skiing, base jumping, bungee jumping, canyoning, power boating, white water rafting and zorbing. You do not need to disclose : Ball games, horse riding, kite surfing, land boarding, mountain biking, sailing, winter holiday skiing for pleasure, surfing, water skiing or windsurfing.

  • diving (other than as a holiday activity), caving or potholing?
  • climbing outside the UK?
  • extreme sports (for example, base jumping, bungee jumping, white water rafting)?
  • flying (including hang gliding, microlighting, parachuting, etc)?
  • motor car or bike racing on a racing circuit?
Does your work involve any of the following:
Help

Please refer to the Foreign and Commonwealth Office (FCO) www.fco.gov.uk/travel site and click on “Travel advice by country” if you are unsure about the security situation in a country you may visit. Where the FCO advises against any travel to any part of the country you should answer the question as Yes.

  • working at heights externally over 40 feet (12.2 metres) for more than 25% of the time?
  • flying other than as a fare paying passenger, an airline pilot or cabin crew?
  • commercial underwater diving?
  • working on a trawler?
  • tunnelling below ground?
  • being on an oil or gas platform?
  • travelling to countries where there are areas of internal conflict or insecurity?
  • being a member of the Armed Forces, the Armed Forces Reserve or the Territorial Army?
During the last 5 years, have you spent more than 90 days in total in Africa, the Caribbean or Thailand?
Help

If the total amount of time spent in Africa, the Caribbean or Thailand, when added together for the last 5 years exceeds 90 days, you should answer Yes.

Have you been disqualified from driving in the last 5 years?
Have you ever used or injected any drugs that were not prescribed to you?
Help

This includes recreational drugs which are not limited to cocaine, heroin, amphetamines, solvents, etc.

Have you ever:
Help

Even if you have been refused life insurance previously the provider may still be able to consider this application. You will be asked to provide some further details so that your application can be assessed.

  • asked for or been given advice or treatment to reduce the amount you drink?
  • been refused life insurance?
Will the amount of life insurance you are now applying for, added to the amount you already hold, with any insurance company, exceed £750,000? (You need to include any other life insurance application you intend to proceed with.) Or have you taken out more than £250,000 worth of life insurance in total in the last year?
Help

You do not need to include life insurance which is part of a group scheme arranged by your employer (referred to as Death in Service or Group Life Schemes.)

,
About other applicant
Title

Date of birth

What is your height?
Help

Please enter your height (without shoes)

ft
ins
What is your weight?
Help

Please enter your weight (wearing indoor clothes)

st
lbs
Lifestyle
Please select an answer
Help

A smoker is someone who has smoked any cigarettes, cigars, a pipe, used e-cigarettes (whether or not they contain nicotine), or used nicotine replacements at all in the last 12 months.

Please tell us when you stopped smoking
Help

If you have smoked any cigarettes, cigars, a pipe, used e-cigarettes (whether or not they contain nicotine), or used nicotine replacements at all in the last 12 months you are classified as a smoker

per day
years
Units of alcohol per week?
Help

Please enter the approximate units of alcohol consumed per week over the last or a typical month. A glass of wine (250ml) is 2.9 units, pint of ordinary strength beer 2 units, strong/premium beer or cider 3 units or single measure/shot of spirits or bottles of alcopops 1.5 units

Within the last 5 years have you:
Help

You need to disclose if you have had treatment during the last 5 years from a doctor, nurse, psychiatrist, or counsellor as well as any regular ongoing treatment for conditions such as asthma and raised blood pressure. You do not need to disclose hay fever or outpatient-only treatment for injuries or sprains

  • had any form of medical treatment or taken any prescribed treatment?
  • attended or been advised to attend hospital or clinic either as an inpatient or outpatient?
  • seen a doctor or been counselled for anxiety, depression or any other mental or nervous illness?
Are you currently taking any prescribed medication? (ignoring medication related to colds, flu, hay fever, pregnancy, back or knee pain, fractures, HRT)
Have any of your natural parents, brothers or sisters been diagnosed as having angina, a heart attack, stroke, bowel cancer, colon cancer, breast or ovarian cancer, Huntington's disease, polycystic kidney disease or any inherited condition before they were 65?
Help

By 'inherited condition' , we mean one or any of: Alports syndrome, Alzheimer's disease or dementia, Diabetes, Dysplastic naevus syndrome, Familial Adenomatous Polyposis of the colon (FAP), Familial Hypercholesterolaemia, Haemochromatosis, Hypertrophic Obstructive Cardiomyopathy (HOCM), Motor Neurone Disease, Multiple Sclerosis, Muscular Dystrophy, Parkinson's disease, Porphyria, Sub arachnoid haemorrhage or TIA, Tuberous sclerosis. If you're adopted or estranged from your family and do not know their medical history you can respond no to this question.

Have you been diagnosed with, received any treatment, or been referred for investigation or tests, for:
Help

This includes any such diagnosis, treatment, referral or investigation/test you have ever had for these conditions.

  • chest pain, a heart attack, or any other heart condition?
  • a stroke or transient ischaemic attack (TIA, a minor form of stroke)?
  • brain haemorrhage or brain injury?
  • diabetes?
  • cancer, leukaemia, Hodgkin's disease, lymphoma or any other form of tumour?
Have you been diagnosed with, received any treatment, or been referred for investigation or tests, for:
Help

This includes any such diagnosis, treatment, referral or investigation/test you have ever had for these conditions.

  • kidney failure?
  • paralysis?
  • multiple sclerosis?
  • blurred or double vision?
  • loss of feeling, numbness or pins and needles serious enough to have been reported to a doctor?
Apart from any medical conditions you've already told us about, are you:
Help

You need to disclose if you have any current or recent symptoms you have experienced which are being investigated, about to be treated or for which you are intending to see a doctor, nurse, psychiatrist, or counsellor. You do not need to disclose such symptoms if you are planning to see or be treated by a chiropodist, chiropractor, dentist, osteopath or physiotherapist.

  • currently intending to seek any medical advice?
  • currently undergoing or awaiting medical investigations or tests?
  • waiting for any form of treatment to start?
Have you ever tested positive for HIV/AIDS or hepatitis B or C, or are you awaiting the results of such a test? (If the result of a test you're waiting for turns out to be negative, the fact that you had a test won't affect the acceptance terms the provider offers you.)
Do you take part in any of the following activities:
Help

Extreme sports include activities such as advanced competitive skiing, base jumping, bungee jumping, canyoning, power boating, white water rafting and zorbing. You do not need to disclose : Ball games, horse riding, kite surfing, land boarding, mountain biking, sailing, winter holiday skiing for pleasure, surfing, water skiing or windsurfing.

  • diving (other than as a holiday activity), caving or potholing?
  • climbing outside the UK?
  • extreme sports (for example, base jumping, bungee jumping, white water rafting)?
  • flying (including hang gliding, microlighting, parachuting, etc)?
  • motor car or bike racing on a racing circuit?
Does your work involve any of the following:
Help

Please refer to the Foreign and Commonwealth Office (FCO) www.fco.gov.uk/travel site and click on “Travel advice by country” if you are unsure about the security situation in a country you may visit. Where the FCO advises against any travel to any part of the country you should answer the question as Yes.

  • working at heights externally over 40 feet (12.2 metres) for more than 25% of the time?
  • flying other than as a fare paying passenger, an airline pilot or cabin crew?
  • commercial underwater diving?
  • working on a trawler?
  • tunnelling below ground?
  • being on an oil or gas platform?
  • travelling to countries where there are areas of internal conflict or insecurity?
  • being a member of the Armed Forces, the Armed Forces Reserve or the Territorial Army?
During the last 5 years, have you spent more than 90 days in total in Africa, the Caribbean or Thailand?
Help

If the total amount of time spent in Africa, the Caribbean or Thailand, when added together for the last 5 years exceeds 90 days, you should answer Yes.

Have you been disqualified from driving in the last 5 years?
Have you ever used or injected any drugs that were not prescribed to you?
Help

This includes recreational drugs which are not limited to cocaine, heroin, amphetamines, solvents, etc.

Have you ever:
Help

Even if you have been refused life insurance previously the provider may still be able to consider this application. You will be asked to provide some further details so that your application can be assessed.

  • asked for or been given advice or treatment to reduce the amount you drink?
  • been refused life insurance?
Will the amount of life insurance you are now applying for, added to the amount you already hold, with any insurance company, exceed £750,000? (You need to include any other life insurance application you intend to proceed with.) Or have you taken out more than £250,000 worth of life insurance in total in the last year?
Help

You do not need to include life insurance which is part of a group scheme arranged by your employer (referred to as Death in Service or Group Life Schemes.)

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