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Serious Illness Quote
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Name
*
First
Last
Email
*
Phone
*
Smoker Status
*
Smoker
Smoker
Non - Smoker
Date of Birth
Sex
*
Male
Male
Female
Serious Illness Cover
*
Minimum Serious Illness Cover is 10% of the Life Cover amount. Also, as any serious illness claim pay Out ,acts as an advance payment of the life cover, it Cannot exceed the life cover amount.
Term of policy
*
Number of years that you require policy
Basis of Cover
Single Person - 1 Person - Single Pyout
Joint Cover - 2 people - Single Payout
Single Cover- One person to be covered Joint Cover- Two people coverage, with payout on first person to claim, per benefit.
Frequency
*
Monthly
Annually
Indexation
*
Yes
No
I have read and understand the terms and conditions and privacy policy
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Agree
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