Elementor #4503

PLAN DETAILS

This section contains the information we need to calculate a quotation for you.
1. Date Of Birth – Applicants should be between 16 and 60 years of age

2. Preferred monthly benefit – Note that this amount cannot exceed 70% of your current income and the maximum level of cover is £33,600 per year.

3. Preferred term – This is the maximum period for which you can receive a benefit while off work due to an illness or accident
1 Year2 YearsPlease quote both options
4. Preferred waiting period before making a claim – This is the period you must be off work before you can make a claim
1 week4 weeks8 weeks13 weeks26 weeks*52 weeks*
*Only available with a 2-year term policy

YOUR CONTACT DETAILS

5. This section contains the information we need to contact you with a quotation.
Title
—MrMrsMsMissDrLordLadyRevSirDame
First Name

Last Name

Telephone Number

Email

When is the best time to contact you?

Any additional comments / questions or information

Note: Simply Income Protection is only available for those who meet various health and lifestyle conditions, such as smoking fewer than 12 cigarettes per day and having a BMI between 18 and 32 (calculate your BMI). If you do not meet the criteria for this insurance plan, would you be happy for our Adviser to discuss other more suitable Income Protection plans with you?
YesNo

I agree that my details contained within this form can be used by Precise Protect Ltd. and its appointed representatives to contact me.
YesNo

Thank you for your interest