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Income Protection Insurance |
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Gender:* |
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Tobacco Use:* |
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Annual Income:* |
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Occupation:* |
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Date of Birth:* |
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How much income protection
insurance do you require? |
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Estimate the amount you require to maintain your current lifestyle. This includes living expenses, mortgages and other repayments
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How long would you like to wait
before receiving your first payment? |
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This is known as the "waiting period". This is the time you wait between making your claim and receiving your first payment. The longer the waiting period the lower the premium.
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How long do you want the benefit to
be paid? |
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This is the length of time the benefit will be paid. Generally, the shorter the benefit period the less the premium.
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Do you take prescription medications? If yes state name of medication
dosage and condition it is treating:* |
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Has any of your parents had
cardiovascular disease or cancer? If
so state which one: |
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Have you ever been treated for any of the following: |
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Name:* |
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Suburb / Town: |
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State:* |
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Postcode:* |
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Phone:* |
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Mobile:* |
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Email:* |
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Preferred Time To Call* |
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Comments: |
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