Income Protection Quote | Axess Financial Services

Life 1

Life 2

Title

Name 1 - First

Name 2 - First

Name 1 - Last

Name 2 - Last

Email 1

Email 2

Sex 1

Male Female

Sex 2

Male Female

Smoker ?

Smoker

Smoker Non - Smoker

Smoker

Smoker Non - Smoker

Date of Birth Applicant 1

Day

Month

Year

Date of Birth Applicant 2

Day

Month

Year

Your Occupation

Occupation

Additional information for a more accurate quote (optional)

Height

Feet

Inches

Feet

Inches

Or cms

Applicant 1: cms

Applicant 2: cms

Weight

Weight : st/lbs

Stones

Pounds

Stones

Pounds

Or kgs

Applicant 1: kgs

Applicant 2: kgs

Waist Measure

Waist: inches or cms

Inches

Cms

Inches

Cms

Policy Requirement

Quotation based on

Quotation type

Benefit Premium

Selecting Benefit, quotes for premium/cost. Premium based quotes for maximum benefit for the premium.

Benefit amount Annual(max 55% of income)

Premium - if based on premium

[If benefit is greater than policy max, premium will reduce accordingly]

Benefit frequency

Frequency

Monthly Annual

[to receive monthly or annual payments]

Policy Term: choose years or to age

Years

To Age

Retirement age

R age

Annual income including dividend

Annual dividend

Deferred period in months

Benefit period

Benefit period input

12 m 24 m Term of Contract

Policy Options

Benefit escalation

Escalation Options

Level RPI

Cover to remain static or increase annually with retail price index.

Policy features

State ben?

insure for non receipt of state benefit

GIO?

Include guaranteed insurability option

Premium type

P type input

Guaranteed Reviewable

Employment type

Emp type input

Employed Self employed Both

Policy Commencement (Optional)

Start date

Message

Acceptance

I / We understand that premium provided is for guidance purposes only and can change based health information on application. A Quote is not guarantee of life / health insurance.

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