(Life Insurance) SPTM

1

First things first ... Do you have a current life insurance policy?

Yes

Not Yet

2

Do you know how much you're currently paying each month for your life insurance?* This field is required.

I know how much I'm paying

I'm not sure

3

How much are you paying?Your best guess is fine

4

Who are you interested in insuring?

Just me

Me and my partner

5

6

How much is your property worth?Your best guess is fine

€0 - €100,000

€100,000 - €250,000

€250,000 - €500,000

€500,000 - €750,000

€750,000 +

7

What is your remaining mortgage balance?Your best guess is fine

8

How many years are left on your mortgage?

9

In which province is your property located?* This field is required.

Ulster

Leinster

Connacht

Munster

10

Do you smoke?* Have you smoked in the past 12 months

Smoker

Non-Smoker

11

What's your date of birth?

12

What's your partner's date of birth?Your best guess is fine

13

Does your partner smoke?* Have they smoked in the past 12 months

Smoker

Non-Smoker

14

Who's your current insurer?Your best guess is fine

Zurich, Irish Life, AIB etc.

15

In the past 5 years, did you have special terms imposed on a past policy OR have you been treated for any serious health conditions like heart problems, liver problems, diabetes, MS, or cancer?

YESNO

16

What's your name?* This field is required.

First Name

Last Name

17

What's the best email to reach you?* This field is required.

18

What's the best number to reach you on?* This field is required.Due to the nature of mortgage protection insurance, we need to verify some basic medical history over the phone before your quotes are issued. Please ensure your phone number is correct.