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Way More Solutions Insurance Quote
1
Who is the insurance cover for?
*
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Myself
Myself & My Partner
Business
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2
What type of business insurance are you looking for?
*
This field is required.
You can select more than one option if required
Shareholder & Partnership Protection
Keyman Insurance
Loan Protection
Relevant Life Plans
Company Private Medical Insurance
Not sure
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3
Size of company
*
This field is required.
How many employees do you have?
1-5 employees
6-10 employees
11-20 employees
21-50 employees
51-100 employees
100+ employees
1-5 employees
6-10 employees
11-20 employees
21-50 employees
51-100 employees
100+ employees
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4
Company Name
*
This field is required.
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5
Company Postcode
*
This field is required.
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6
What type of insurance are you looking for?
*
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Life Insurance
Critical Illness Cover
Income Protection
Family Income Benefit
Private Medical Insurance
Personal Accident Plans
Funeral Plan Cover
Not sure
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7
What type of insurance are you looking for?
*
This field is required.
Life Insurance
Critical Illness Cover
Income Protection
Private Medical Insurance
Not sure
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8
Who is the medical insurance to cover?
Just Me
Myself & My Partner
Myself & My Family
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9
Have you smoked or taken nicotine products in the last 12 months?
*
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Yes
No
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10
Have you or your partner smoked or taken nicotine products in the last 12 months?
*
This field is required.
No, neither of us
Yes, just me
Yes, just my partner
Yes, both of us
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11
How much insurance cover would you like?
*
This field is required.
Not sure
£10,000
£20,000
£30,000
£40,000
£50,000
£60,000
£70,000
£80,000
£90,000
£100,000 - £250,000
£250,000 - £500,000
£500,00 - £1m
£1m +
Not sure
£10,000
£20,000
£30,000
£40,000
£50,000
£60,000
£70,000
£80,000
£90,000
£100,000 - £250,000
£250,000 - £500,000
£500,00 - £1m
£1m +
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12
What monthly income would you need to cover your bills?
£500 - £1000
£1000 - £3000
£3000 - £5000
£5000 +
£500 - £1000
£1000 - £3000
£3000 - £5000
£5000 +
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13
What monthly income would you like to leave your family?
*
This field is required.
£500 - £1000
£1000 - £3000
£3000 - £5000
£5000 +
£500 - £1000
£1000 - £3000
£3000 - £5000
£5000 +
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14
How long would you like the cover for?
*
This field is required.
Not sure
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
13 years
14 years
15 years
16 years
17 years
18 years
19 years
20 years
21 years
22 years
23 years
24 years
25 years
26 years
27 years
28 years
29 years
30 years
30+ years
20 years
Not sure
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
13 years
14 years
15 years
16 years
17 years
18 years
19 years
20 years
21 years
22 years
23 years
24 years
25 years
26 years
27 years
28 years
29 years
30 years
30+ years
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15
Date of Birth
*
This field is required.
This will help us give you a more accurate quote
-
Day
Month
Year
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16
Partners Date of Birth
*
This field is required.
This will help us give you a more accurate quote
-
Day
Month
Year
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17
Family Members Date of Birth & Relationship to you
Fill in all applicable date of births of family members to include in the medical insurance
e.g. 01-10-2008 Daughter
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18
Current Postcode
*
This field is required.
This will help us know where you are located
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19
Do you have an existing insurance plan?
*
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Yes
No
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20
Contact Name
*
This field is required.
First Name
Last Name
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21
Contact Phone Number
*
This field is required.
If providing a landline number, please remember to include your area code
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22
Email
*
This field is required.
example@example.com
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23
How would you prefer to be contacted?
*
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Email
Phone
No Preference
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24
Opt in for offers and updates?
Yes
No
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25
Get My Insurance Quote
*
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