Life Assurance Online is a site designed to help you obtain a cheap quote for Life Insurance, Critical Illness Insurance, Income Protection Insurance and other insurance products. All requests and information you provide through this site will be dealt with by Face to Face Finance (Anglia) Ltd which is regulated by the Financial Services Authority. They are able to research the whole UK life insurance market on your behalf.

This site is intended for UK residents and British expatriates only.

Critical Illness Insurance Quote Form

This form caters for level insurance cover and decreasing insurance cover. If you need critical illness insurance cover combined with life insurance please use our Life Insurance Quote Forms where you can add critical illness as an option.

We kindly ask you to complete all fields highlighted in red to provide you with a quote.

Single Applicant

Joint Applicant

Title

First Name

Surname

Date of Birth

Male/Female

Smoker

Occupation

Address 1

Address 2

Town/City

County

Post Code

Telephone Number

When can we contact you on this telephone number?

Nationality

Country of Residence

Email Address

Amount of Cover Required

How Long For

years

Type of Cover

Level Decreasing

Premium Protection Required?

Yes
No What does this mean?

Priority response required?

Yes Not Urgent

If you require clarification on your options please tick

How did you find us?

If you selected 'Search Engine', please specify

Additional comments

As a further service, we would like to keep you informed by email of new developments and activities in the insurance and financial planning markets, possibly in the form of a newsletter. If you would like to receive further information please select Yes on the pop up menu.

Please click on SEND once or CLEAR to re-enter.

Please note that quotations are subject to underwriting and premiums cannot be guaranteed until confirmed by the assurance company.