First Applicant
Title
Initials
First Name
Surname
Date of birth
Occupation
Employer
Length of service

Gross monthly income
Second Applicant
Title
Initials
First Name
Surname
Date of birth
Occupation
Employer
Length of service

Gross monthly income
Property Address
Address 1
Address 2
Address 3
Address 4
Postcode
Contact telephone
Email Address
Type of cover
Qualification period
Type of borrower

A new borrower is a customer whose mortgage loan or rental agreement commenced less than 30 days before the policy start date.

An existing borrower is a customer whose mortgage loann or rental agreement commenced more than 30 days before the policy start date.

Monthly benefit
Monthly mortgage payment
£
Monthly building & contents payment
£
Monthly life cover payment
£
And / Or
 
Monthly rental payment
£
And / Or
 
Monthly loan payment
£
Total
£
25% extra required

The maximum monthly benefit you can insure is £1500 or 65% of your monthly income, whichever is the lower.