My Term Assurance Quotation - Death by Any Cause

My Term Assurance Quotation
Death by Any Cause

Personal Details

Family Name *

Gender *

Given Name *

Smoking Status *

Email *

Date of Birth *

To be considered a non-smoker, you must not have used any form of tobacco or any nicotine-based products within the last 12 months.

Tobacco/nicotine-based products include cigarettes, cigars, pipe tobacco, shisha, chewing tobacco, nicotine patches, nicotine gum, and electronic cigarettes.

Nationality *

Residence *

Telephone *

Education and Income Details

Education Level

Why do we ask for Education Level and Income?

These help us determine the fairest pricing for every applicant, as higher levels of education and income may result in a discount to a person’s nationality or residence pricing. (Note that this will never result in a higher premium)

Income
(in Policy Currency)

Please enter only numbers. Do not type commas, periods or other characters

What counts as income?

This should be Annual Average Household Income from all sources. This means employment income, including a spouse’s income as well as any other regular income such as rent received or investment income, as long as you receive these each year.

Cover Details

Currency *

Term Length *

Cover Level *USD

Maximum Cover Levels for AD benefit is
USD 1,000,000 ● GBP 800,000 ● EUR 900,000

Optional Rider Benefits

Accidental Death Benefit

This optional benefit pays an additional amount equal to 50% of the Death Benefit Sum Assured if death is as a direct result of an accident. Please refer to our Terms and Conditions and Policy Guide for full details of this benefit.

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