Unemployment Insurance

General information all questions must be answered to submit an enquiry.

Please complete the form below and we will recommend the most appropriate plan from our panel.

Salutation Forename Surname Information DOB
/ /
  Please enter your email address:
  Please re-enter your email address:
Information Please enter a contact telephone number:
  When is the best time to contact you:
  Please enter your postcode:

Underwriting information this will help us recommend the most appropriate policy.

Information What is your occupation?:
  In which industry do you work?:
Information How many hours per week do you work?:
Information Are you aware of anything that may result in you becoming unemployed?: Yes No
  Has your employer made anyone redundant in the last 12 months?: Yes No
Information How long have you been in continuous employment?: YearsMonths
  How long have you been in your current employment?: YearsMonths

Some providers will only cover regular commitments please advise how the total benefit would be split:

  Please advise your total annual income:
  Mortgage / Rent:
  HP / Loans:
  Credit Card Payments:
  Utility Bills:
  Insurance / Council Tax:
  Education Fees:
  Regular monthly outgoings you wish to cover?:
  Additional benefit required:
  Total benefit required?:

Quote Information.

Information Please indicate whether you would prefer an excess or waiting period?:
  Please select the benefit period you require?:
  Please advise what type of cover you require?:

* Additional information will help us recommend the most appropriate policy.

Information Do you have any existing plans of this type?: Yes No
  If so do you intend to cancel these?: Yes No
Please use this space to provide us with any additional information that you think is relevant.