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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Total life cover value: £0

This is an illustration of the amount of life insurance you may need based on the information you've provided. It should not be taken as a recommendation or advice.

Consider things like when your mortgage comes to an end, and when your family and dependants would become self sufficient.
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About You (First Applicant)

We recognise not all titles are included here and so may not represent you as it should.
Postcode
We'll send you a confirmation email with your insurance quotes.
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.
Select how you measure your height
We need your height without shoes on
Select how you measure your weight
We need your weight to include wearing clothes

Lifestyle

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.
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.
For example, a drink is a glass of wine or a glass or bottle of beer.
  • 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?
  • 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?
  • 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
  • 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?
  • 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)?
  • 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?
  • 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?
  • 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
  • Recreational drugs, for example cocaine, ecstasy, heroin
  • Methadone
  • Anabolic steroids not prescribed by a doctor
  • 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?
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About other applicant

We recognise not all titles are included here and so may not represent you as it should.
Postcode
Select how you measure your height
We need your height without shoes on
Select how you measure your weight
We need your weight to include wearing clothes

Lifestyle

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.
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.
For example, a drink is a glass of wine or a glass or bottle of beer.
  • 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?
  • 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?
  • 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
  • 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?
  • 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)?
  • 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?
  • 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?
  • 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
  • Recreational drugs, for example cocaine, ecstasy, heroin
  • Methadone
  • Anabolic steroids not prescribed by a doctor
  • 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?