Life Insurance

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It's important to answer questions truthfully, accurately and completely. If you don't, your policy could end up being amended, cancelled, or a claim not being paid.

Your policy details

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What do you need the insurance to protect?

About You (First Applicant)

Title

We recongise not all titles are included here and so may not represent you as it should.

Why isn't my title listed?

For now these titles are what our system and insurance providers use. We're working to add in more inclusive titles.

Select the policyholder's title

Mrs

Miss

First name Enter the policyholder's first name

Surname Enter the policyholder's surname

Date of birth Enter the birth day, month and year as numbers Please select a valid date of birth.

Day

Month

Year

Postcode

Please enter a valid UK postcode.

Email address

We'll send you a confirmation email with your insurance quotes.

Please enter a valid email address.

Telephone number

Providing your phone number is optional but will allow us to contact you to assist with your life insurance quotation. Providing your phone number is consent for us to contact you to offer assistance.

Please enter a valid phone number

What's your height?

Select how you measure your height

Select if you measure in centimetres or feet/inches

Centimetres

Feet/inches

We need your height without shoes on

Enter a height between 91.44 - 210.82 cm. If you're shorter or taller, call 0800 422 0060 for further help Enter a height between 3ft - 6ft 11. If you're shorter or taller, call 0800 422 0060 for further help Allowable range 3ft - 6ft 11 inches. If outside of this range, please call 0800 422 0060. Allowable range 92cm - 211cm. If outside of this range, please call 0800 422 0060.

Feet

Inches

Centimetres

What's your weight?

Select how you measure your weight

Select if you measure in kilograms or stones/pounds

Kilograms

Stone/pounds

We need your weight to include wearing clothes

Enter a weight between 31.75 - 153.23kg. If weight is outside this range, call 0800 422 0060 for further help Enter a weight between 5st - 24st 13lbs. If weight is outside this range, call 0800 422 0060 for further help Allowable range 5st - 24st 13lbs. If outside of this range, please call 0800 422 0060. Allowable range 32kg - 158kg. If outside of this range, please call 0800 422 0060.

Stone

Pounds

Kilograms

Lifestyle

Do you smoke?

If you've smoked in the last 12 months you're classed as a 'current smoker'. This includes cigars, pipes, e-cigarettes, nicotine replacements and regular cigarettes.

How do you class smokers?

Please select the option from the list that reflects your smoking history. A smoker is someone who smokes cigarettes or cigars / uses a pipe or other tobacco product / uses nicotine replacement products including e-cigarettes.

Select if the policyholder has ever smoked

Yes - current smoker

Yes - ex-smoker

No - never smoked

When did you quit?

If you've quit within last 12 months or used a nicotine replacement within this timeframe you're classed as a smoker.

More details

If you have smoked or used any tobacco products (including cigars, a pipe, cigarettes or nicotine replacement products) in the last 12 months then you are classified as a smoker.

Less than 12 months ago

More than 12 months ago

On average, how many cigarettes or equivalent did you or do you smoke per day? Enter policyholder's average daily amount of cigarettes or equivalent

Per day

How many years ago did you quit smoking? Enter how many years it's been since the policyholder quit smoking to the nearest year

years This field cannot be blank

You must answer this question.

During a typical week, how many alcoholic drinks do you have?

For example, a drink is a glass of wine or a glass or bottle of beer.

Enter the amount of drinks the policyholder normally has per week. Enter 0 if the policyholder doesn't drink This field must be a number. Units of Alcohol must be between 0 and 99.

What is your trouser size in UK inches?

More details

Please use the size from the most recent clothing purchase you made for yourself.

You must answer this question.

The field must be a minimum of 2 digits

What is your dress, skirt or trouser size?

More details

Please use the size from the most recent clothing purchase you made for yourself. If you're pregnant, please advise your size prior to this pregnancy.

You must answer this question.

During the last 2 years, have you seen a health professional about:

a blood condition for example anaemia, blood clot?
a lung or breathing condition for example asthma, bronchitis, chronic obstructive lung disease, emphysema. Please ignore hay fever and isolated chest infections from which you have fully recovered?
a condition affecting your stomach, bowel or oesophagus for example Crohn's disease, ulcerative colitis. Please ignore diarrhoea, food poisoning, sickness or vomiting, stomach bug or upset provided you have fully recovered?
any type of arthritis or gout?
a growth, lump, polyp or tumour?
anxiety, depression or any other type of mental illness?
any other condition for which you are required to attend review or follow-up, including medication review, or a condition for which you have been admitted overnight to hospital. Please ignore accidents and injuries from which you have fully recovered?

You must answer this question.

Yes

During the last 2 years, have you seen a health professional about:

a blood condition for example anaemia, blood clot?
a lung or breathing condition for example asthma, bronchitis, chronic obstructive lung disease, emphysema. Please ignore hay fever and isolated chest infections from which you have fully recovered?
a condition affecting your stomach, bowel or oesophagus for example Crohn's disease, ulcerative colitis. Please ignore diarrhoea, food poisoning, sickness or vomiting, stomach bug or upset provided you have fully recovered?
any type of arthritis or gout?
a growth, lump, polyp or tumour?
anxiety, depression or any other type of mental illness?
any other condition for which you are required to attend review or follow-up, including medication review, or a condition for which you have been admitted overnight to hospital. Please ignore accidents and injuries from which you have fully recovered or pregnancy, contraceptive and infertility medication?

You must answer this question.

Yes

Have any of your natural parents, brothers or sisters, before the age of 60, had any of the following?

Alzheimer's disease or dementia
Cancer of the bowel (colon), breast or ovary
Cardiomyopathy
Heart attack, diabetes or stroke
Huntington's disease
Motor neurone disease
Multiple sclerosis
Myotonic Dystrophy
Parkinson's disease
Polycystic kidney disease
Any other condition that runs in your family and that you're receiving regular follow up or screening for
Don't know

You must answer this question.

Yes

In the last 30 days have you:

had a new or unexplained continuous cough, fever or high temperature, loss of smell or taste?
tested positive for or been diagnosed with coronavirus/COVID-19?

You must answer this question.

Yes

In the last 14 days, have you:

had any symptoms of coronavirus/COVID-19?
had direct contact with someone who has been diagnosed with, or suspected of having Coronavirus?

You must answer this question.

Yes

In the last 14 days, have you been self-isolating or been advised you should self-isolate for any of the reasons below:

More details

Please answer no if you are following general social-distancing advice to avoid spread of the virus or working from home due to workplace advice only

Because you or someone you live with is currently pregnant?
Because someone you live with is elderly or in poor health?
Because you decided to self-isolate of your own accord?
Been following general social-distancing advice or working from home due to workplace advice?

You must answer this question.

Yes

In the last 14 days, have you been self- isolating or been advised you should self-isolate for any of the reasons below:

More details

Please answer no if you are following general social-distancing advice to avoid spread of the virus or working from home due to workplace advice only

As a precaution because of your age or an existing medical condition?
Because you have had direct contact with, someone diagnosed with or suspected of having coronavirus/COVID-19 and decided to self-isolate?
Because you experienced symptoms of coronavirus/COVID-19 and decided to self-isolate?
For another reason not mentioned above?

You must answer this question.

Yes

Have you ever:

had diabetes, excess sugar in the blood or a heart condition for example angina, heart attack, heart valve problem, heart surgery?
had a stroke, transient ischaemic attack (TIA) or a brain haemorrhage?
had cancer, Hodgkin's disease, Non-Hodgkin's lymphoma, leukaemia, a melanoma or a brain tumour?
had a neurological condition for example cerebral palsy, epilepsy, motor neurone disease, multiple sclerosis, muscular dystrophy, optic neuritis, paralysis, Parkinson's disease
been admitted overnight to hospital or referred to a psychiatrist for mental illness, anorexia or bulimia?
tested positive for HIV, or are you waiting for the result of an HIV test?

You must answer this question.

Yes

During the last 5 years, have you seen a health professional about:

More details

Please ignore routine cervical smears if the results have been normal. Please ignore birthmarks where no treatment or specialist referral has been advised.

raised blood pressure?
raised cholesterol?
a condition affecting your kidney, bladder, liver or pancreas for example kidney stones, hepatitis, fatty liver?
chest pain, palpitations or irregular heartbeat, numbness, persistent tingling or pins and needles, memory loss, dizziness, balance problems, lupus, tremor or facial pain other than dental pain?
a mole or freckle?
any condition affecting your ears or hearing (for example Meniere's disease or deafness), or eyes or vision not wholly corrected by spectacles, lenses or laser treatment, (for example cataract, blindness)?
any gynaecological condition for which you've not yet been discharged from follow up, or a cervical smear requiring further investigations?

You must answer this question.

Yes

During the last 5 years, have you seen a health professional about:

More details

Please ignore birthmarks where no treatment or specialist referral has been advised.

raised blood pressure?
raised cholesterol?
a condition affecting your kidney, bladder, liver or pancreas for example kidney stones, hepatitis, fatty liver?
chest pain, palpitations or irregular heartbeat, numbness, persistent tingling or pins and needles, memory loss, dizziness, balance problems, lupus, tremor or facial pain other than dental pain?
a mole or freckle?
any condition affecting your ears or hearing (for example Meniere's disease or deafness), or eyes or vision not wholly corrected by spectacles, lenses or laser treatment, (for example cataract, blindness)?

You must answer this question.

Yes

During the last 3 months, have you had:

unexplained bleeding, weight loss, lump or growth?
breast or testicular changes of any sort?
a mole or freckle that has bled or changed in appearance or any other changes to your skin?
any other symptom for which you may see a health professional about for the first time?

You must answer this question.

Yes

Do you regularly take part in any of the following activities for work or recreation?

More details

You can ignore one off parachute jumps

Flying (other than as a fare-paying passenger)
Hang gliding or paragliding
Motor car or motorcycle sport
Mountaineering or rock climbing
Parachuting, sky diving or BASE jumping
Underwater diving
Any other extreme sport

You must answer this question.

Yes

During the last 2 years have you spent more than 90 consecutive days in Africa, the Caribbean, Russia, Thailand or Ukraine?

You must answer this question.

Yes

During the next 2 years do you intend to spend more than 30 consecutive days outside the UK, EU, USA, Canada, Australia or New Zealand ?

More details

You can ignore travel as a member of the Armed Forces

You must answer this question.

Yes

Do you work outside at heights over 15 metres (50ft), offshore in the oil, gas or fishing industry, in the Armed Forces or as a member of the army reserve

You must answer this question.

Yes

During the last 5 years have you been disqualified from driving for a motoring offence or convicted of careless or reckless driving?

You must answer this question.

Yes

During the last 5 years have you used any of the following?

More details

We'll only use the answer to this question to assess your application and at claim stage. Therefore there are no 'legal implications' in answering yes to this question.

Recreational drugs, for example cocaine, ecstasy, heroin
Methadone
Anabolic steroids not prescribed by a doctor

You must answer this question.

Yes

Have you ever been:

told by a health professional that you should reduce the amount of alcohol you have because you were drinking too much?
seen by an alcohol specialist or attended an alcohol support group or been told that you have any liver damage?

You must answer this question.

Yes

Including this application, what is the total amount of life and critical illness cover you will have?

More details

Please include any applications being made to another insurer but ignore cover that will be cancelled if this policy goes ahead.

You must answer this question.

Total amount is required The field Amount of cover must be a number. Total amount must not be less than the sum assured.

Tick the box to continue getting a quote. For more information on Direct Life and Pension Services, see their privacy policy.

I consent to Direct Life and Pension Services Ltd (DLPS) processing my personal data to provide a life insurance service and sharing data with confused.com and quoting Insurers. I have read and accept the DLPS privacy policy and understand that I can withdraw consent at any time.

About other applicant

Title

We recongise not all titles are included here and so may not represent you as it should.

Why isn't my title listed?

For now these titles are what our system and insurance providers use. We're working to add in more inclusive titles.

Select the policyholder's title

Mrs

Miss

First name Enter the policyholder's first name

Surname Enter the policyholder's surname

Date of birth Enter the birth day, month and year as numbers Please select a valid date of birth.

Day

Month

Year

Postcode

Please enter a valid UK postcode.

What's your height?

Select how you measure your height

Select if you measure in centimetres or feet/inches

Centimetres

Feet/inches

We need your height without shoes on

Feet

Inches

Centimetres

What's your weight?

Select how you measure your weight

Select if you measure in kilograms or stones/pounds

Kilograms

Stone/pounds

We need your weight to include wearing clothes

Stone

Pounds

Kilograms

Lifestyle

Do you smoke?

If you've smoked in the last 12 months you're classed as a 'current smoker'. This includes cigars, pipes, e-cigarettes, nicotine replacements and regular cigarettes.

How do you class smokers?

Select if the policyholder has ever smoked

Yes - current smoker

Yes - ex-smoker

No - never smoked

When did you quit?

If you've quit within last 12 months or used a nicotine replacement within this timeframe you're classed as a smoker.

More details

If you have smoked or used any tobacco products (including cigars, a pipe, cigarettes or nicotine replacement products) in the last 12 months then you are classified as a smoker.

Less than 12 months ago

More than 12 months ago

On average, how many cigarettes or equivalent did you or do you smoke per day? Enter policyholder's average daily amount of cigarettes or equivalent

Per day

How many years ago did you quit smoking? Enter how many years it's been since the policyholder quit smoking to the nearest year

years This field cannot be blank

You must answer this question.

During a typical week, how many alcoholic drinks do you have?

For example, a drink is a glass of wine or a glass or bottle of beer.

Enter the amount of drinks the policyholder normally has per week. Enter 0 if the policyholder doesn't drink This field must be a number. Units of Alcohol must be between 0 and 99.

What is your trouser size in UK inches?

More details

Please use the size from the most recent clothing purchase you made for yourself.

You must answer this question.

The field must be a minimum of 2 digits

What is your dress, skirt or trouser size?

More details

Please use the size from the most recent clothing purchase you made for yourself. If you're pregnant, please advise your size prior to this pregnancy.

You must answer this question.

During the last 2 years, have you seen a health professional about:

a blood condition for example anaemia, blood clot?
a lung or breathing condition for example asthma, bronchitis, chronic obstructive lung disease, emphysema. Please ignore hay fever and isolated chest infections from which you have fully recovered?
a condition affecting your stomach, bowel or oesophagus for example Crohn's disease, ulcerative colitis. Please ignore diarrhoea, food poisoning, sickness or vomiting, stomach bug or upset provided you have fully recovered?
any type of arthritis or gout?
a growth, lump, polyp or tumour?
anxiety, depression or any other type of mental illness?
any other condition for which you are required to attend review or follow-up, including medication review, or a condition for which you have been admitted overnight to hospital. Please ignore accidents and injuries from which you have fully recovered?

You must answer this question.

Yes

During the last 2 years, have you seen a health professional about:

a blood condition for example anaemia, blood clot?
a lung or breathing condition for example asthma, bronchitis, chronic obstructive lung disease, emphysema. Please ignore hay fever and isolated chest infections from which you have fully recovered?
a condition affecting your stomach, bowel or oesophagus for example Crohn's disease, ulcerative colitis. Please ignore diarrhoea, food poisoning, sickness or vomiting, stomach bug or upset provided you have fully recovered?
any type of arthritis or gout?
a growth, lump, polyp or tumour?
anxiety, depression or any other type of mental illness?
any other condition for which you are required to attend review or follow-up, including medication review, or a condition for which you have been admitted overnight to hospital. Please ignore accidents and injuries from which you have fully recovered or pregnancy, contraceptive and infertility medication?

You must answer this question.

Yes

Have any of your natural parents, brothers or sisters, before the age of 60, had any of the following?

Alzheimer's disease or dementia
Cancer of the bowel (colon), breast or ovary
Cardiomyopathy
Heart attack, diabetes or stroke
Huntington's disease
Motor neurone disease
Multiple sclerosis
Myotonic Dystrophy
Parkinson's disease
Polycystic kidney disease
Any other condition that runs in your family and that you're receiving regular follow up or screening for
Don't know

You must answer this question.

Yes

In the last 30 days have you:

had a new or unexplained continuous cough, fever or high temperature, loss of smell or taste?
tested positive for or been diagnosed with coronavirus/COVID-19?

You must answer this question.

Yes

In the last 14 days, have you:

had any symptoms of coronavirus/COVID-19?
had direct contact with someone who has been diagnosed with, or suspected of having Coronavirus?

You must answer this question.

Yes

In the last 14 days, have you been self-isolating or been advised you should self-isolate for any of the reasons below:

More details

Please answer no if you are following general social-distancing advice to avoid spread of the virus or working from home due to workplace advice only

Because you or someone you live with is currently pregnant?
Because someone you live with is elderly or in poor health?
Because you decided to self-isolate of your own accord?
Been following general social-distancing advice or working from home due to workplace advice?

You must answer this question.

Yes

In the last 14 days, have you been self- isolating or been advised you should self-isolate for any of the reasons below:

More details

Please answer no if you are following general social-distancing advice to avoid spread of the virus or working from home due to workplace advice only

As a precaution because of your age or an existing medical condition?
Because you have had direct contact with, someone diagnosed with or suspected of having coronavirus/COVID-19 and decided to self-isolate?
Because you experienced symptoms of coronavirus/COVID-19 and decided to self-isolate?
For another reason not mentioned above?

You must answer this question.

Yes

Have you ever:

had diabetes, excess sugar in the blood or a heart condition for example angina, heart attack, heart valve problem, heart surgery?
had a stroke, transient ischaemic attack (TIA) or a brain haemorrhage?
had cancer, Hodgkin's disease, Non-Hodgkin's lymphoma, leukaemia, a melanoma or a brain tumour?
had a neurological condition for example cerebral palsy, epilepsy, motor neurone disease, multiple sclerosis, muscular dystrophy, optic neuritis, paralysis, Parkinson's disease
been admitted overnight to hospital or referred to a psychiatrist for mental illness, anorexia or bulimia?
tested positive for HIV, or are you waiting for the result of an HIV test?

You must answer this question.

Yes

During the last 5 years, have you seen a health professional about:

More details

Please ignore birthmarks where no treatment or specialist referral has been advised.

raised blood pressure?
raised cholesterol?
a condition affecting your kidney, bladder, liver or pancreas for example kidney stones, hepatitis, fatty liver?
chest pain, palpitations or irregular heartbeat, numbness, persistent tingling or pins and needles, memory loss, dizziness, balance problems, lupus, tremor or facial pain other than dental pain?
a mole or freckle?
any condition affecting your ears or hearing (for example Meniere's disease or deafness), or eyes or vision not wholly corrected by spectacles, lenses or laser treatment, (for example cataract, blindness)?

You must answer this question.

Yes

During the last 5 years, have you seen a health professional about:

More details

Please ignore routine cervical smears if the results have been normal. Please ignore birthmarks where no treatment or specialist referral has been advised.

raised blood pressure?
raised cholesterol?
a condition affecting your kidney, bladder, liver or pancreas for example kidney stones, hepatitis, fatty liver?
chest pain, palpitations or irregular heartbeat, numbness, persistent tingling or pins and needles, memory loss, dizziness, balance problems, lupus, tremor or facial pain other than dental pain?
a mole or freckle?
any condition affecting your ears or hearing (for example Meniere's disease or deafness), or eyes or vision not wholly corrected by spectacles, lenses or laser treatment, (for example cataract, blindness)?
any gynaecological condition for which you've not yet been discharged from follow up, or a cervical smear requiring further investigations?

You must answer this question.

Yes

During the last 3 months, have you had:

unexplained bleeding, weight loss, lump or growth?
breast or testicular changes of any sort?
a mole or freckle that has bled or changed in appearance or any other changes to your skin?
any other symptom for which you may see a health professional about for the first time?

You must answer this question.

Yes

Do you regularly take part in any of the following activities for work or recreation?

More details

You can ignore one off parachute jumps

Flying (other than as a fare-paying passenger)
Hang gliding or paragliding
Motor car or motorcycle sport
Mountaineering or rock climbing
Parachuting, sky diving or BASE jumping
Underwater diving
Any other extreme sport

You must answer this question.

Yes

During the last 2 years have you spent more than 90 consecutive days in Africa, the Caribbean, Russia, Thailand or Ukraine?

You must answer this question.

Yes

During the next 2 years do you intend to spend more than 30 consecutive days outside the UK, EU, USA, Canada, Australia or New Zealand ?

More details

You can ignore travel as a member of the Armed Forces

You must answer this question.

Yes

Do you work outside at heights over 15 metres (50ft), offshore in the oil, gas or fishing industry, in the Armed Forces or as a member of the army reserve

You must answer this question.

Yes

During the last 5 years have you been disqualified from driving for a motoring offence or convicted of careless or reckless driving?

You must answer this question.

Yes

During the last 5 years have you used any of the following?

More details

We'll only use the answer to this question to assess your application and at claim stage. Therefore there are no 'legal implications' in answering yes to this question.

Recreational drugs, for example cocaine, ecstasy, heroin
Methadone
Anabolic steroids not prescribed by a doctor

You must answer this question.

Yes

Have you ever been:

told by a health professional that you should reduce the amount of alcohol you have because you were drinking too much?
seen by an alcohol specialist or attended an alcohol support group or been told that you have any liver damage?

You must answer this question.

Yes

Including this application, what is the total amount of life and critical illness cover you will have?

More details

Please include any applications being made to another insurer but ignore cover that will be cancelled if this policy goes ahead.

You must answer this question.

Total amount is required The field Amount of cover must be a number. Total amount must not be less than the sum assured.

That's great - we've got everything we need. Get your quote!