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Step 1: Cover Details
Form Legend
Cover Details
Monthly amount to cover
£
Please note the maximum insurable monthly amount is 50% of your gross monthly salary upto a maximum of £2,000.
Need cover up to £3,000 or 90% of Net Income?
Click here
Gross Annual Salary
£
Gross annual salary is your basic salary. Excluding any bonuses, overtime and commission earned.
Date of Birth (dd/mm/yyyy)
Insurance start date (dd/mm/yyyy)
This is the date that you would like your insurance to begin. Please cancel any other mortgage protection insurance that you currently have in force as soon as you have submitted this application. Failure to do so may reduce the amount that we would pay you in the event of a claim.
Mortgage cover only
Mortgage and household bills cover
If you hold a joint mortgage each of you, if eligible, may cover up to 100% of your monthly mortgage repayment.
Step 1:
Cover Details
Step 2:
Your Quote
Step 3:
Your Details
Step 4:
Mortgage Details
Step 5:
Payment Details