Because of the massive array of possible circumstances surrounding the calculation of your life assurance requirements, and policies available, it is difficult to provide on-line facilities for this.

However, we can arrange a basic quotation via our internet service. This is provided by e-mail, and is subject to acceptance of our terms and conditions (see below).

If you would like to receive a quotation, please fill in the form below, and we will get back to you as soon as our advisers have calculated the appropriate life assurance policy. Please note, that all fields are required, and all answers should be provided honestly and as accurately as possible. Please complete the form below, answering all questions as accurately as possible. When you have finished, click Submit and we will do the rest for you.

Name:
Business Name:
Telephone:
Postcode(this is so we can find your local HW office):
Email Address:
	You	Your Partner
What is your age (Years)
Sex	Male Female	Male Female
Marital Status	SingleMarriedDivorcedSeparated	SingleMarriedDivorcedSeparated
UK Resident for tax purposes?	YesNo	YesNo
Number of Dependent Children
Ages of children (if applicable). Please seperate using comma's
Mortgages Value Outstanding (if joint, please enter figure under your heading only)
Total annual gross income
Total Asset Value (if joint, use your heading only)
Total Investment Values (if joint, use your heading only)
Do you smoke?	YesNo	YesNo
How many units of alcohol do you drink in a week?
How tall are you? (in feet/inches)
What is your weight? (in stones/pounds)
Please tick the following boxes as appropriate for the level of cover you require. If you are unsure whether any are needed, please leave these ticked and we will discuss this in more detail with you.	Cover for death of you/your partner Long Term Illness/Disability Cover Critical Illness Cover Private Health Cover Long Term Care Childrens Education Cover Mortgage Repayment Cover Protect your Income
By click the button below you agree to the sites terms and conditions.

Quotes will be based on insurer’s standard rates and will not take into account the client’s state of health which could have a significant impact on the level of cover available and the premiums.