Ariston Bell :: Enquiry Form

Level or Decreasing Life Assurance

What type of policy do I require?

Level Term - The sum assured will remain constant throughout the term of the plan.
This type of policy is appropriate for an interest only mortgage or family protection.

Decreasing Term - The sum assured will decrease throughout the term of the plan.
This type of policy is appropriate for a repayment (capital and interest) mortgage.

Critical Illness - This is an optional extra which can be built into the plan.
This will pay out on the diagnosis of one of a specified list of critical illnesses.

For your quotation, please complete the following:


First Applicant		Second Applicant (If joint policy required)

Title		Title
First Name		First Name
Surname		Surname
Sex	Male Female	Sex	Male Female

Have you smoked in the last 12 months?	Yes No	Have you smoked in the last 12 months?	Yes No
Date of Birth		Date of Birth
Occupation		Occupation

Address
Postcode
Contact Telephone Number
Email Address*

Quotation Details

Is this to cover a mortgage?		Yes No
Plan Type required?		Level Decreasing
Amount of Cover £
Term in years:
Would you like critcial illness cover included?		Yes No
Could we send you details of other services we have to offer from time to time?		Yes No

If you have any queries about this form, or any of the details of the product concerned, please feel free to contact us on 0870 199 3502

Ariston Bell is authorised and regulated by the Financial Services Authority.
Your home may be repossessed if you do not keep up repayments on your mortgage.