Security

The information you provide will only be used for the purpose of obtaining annuity quotations on your behalf.

Providers We Use

Below are some of the highly regarded annuity providers we have used when arranging our customers' annuities.

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Section 1. General Information

Name

Title:
* First Name:
* Surname:
* Email Address:

Contact Details

* Daytime Phone:
Evening Phone:
Mobile Phone:

Your Address

* House / Flat Number:
* Line 1:
Line 2:
Line 3:
* Town / City:
County:
Postcode:

Section 2. Pension / Personal Details

Pension Scheme Details

*Gross Fund Available: £

Part of fund protected rights: £

Lump Sum you Require (Max 25%): £
*Net Fund available after lump sum taken: £

Pension Scheme Preferences

Do you require escalation?:
Do you require a guaranteed period?:
When do you want the annuity to start?: / /
Spouse / partner's pension proportion:

Marital Status:

Underwriting Information

Date Of Birth:
Gender:
Height:
Weight:
Occupation:
Smoker Status:
How many manufactured cigarettes do you smoke or how much rolling tobacco do you consume each week?
Have you smoked at least 70 manufactured cigarettes or 85g of rolling tobacco per week continuously for the last ten years?

Self

Partner/Spouse

Please add any additional information or questions in the box below. Many people with health and lifestyle related conditions could be eligible for an enhanced annuity, even though they may not feel that they have a serious condition.

The simplest way to assess whether you may qualify for an enhanced annuity is to complete our medical questionnaire. This can be downloaded by clicking this link (this document requires Adobe Reader, which can be downloaded free of charge from Adobe by clicking here)"

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