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.

Income Protection Insurance Quote Form

Please complete the form below for an income protection insurance quote. If you need help in filling in the details, please call us on 01603 625100. Fields highlighted in red must be completed.

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

Annual Salary/Trading Profit

Amount of Monthly Cover Required

Level or Increasing Payments

Deferred Period

Quote for Guaranteed or Reviewable Premiums?

Employment Status

	Employed
	Self Employed

Company Director

Term of Years of Plan

years

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.