Insurance Factfind

Insurance Factfind

APPLICANT DETAILS

1st Applicant / 2nd Applicant
Title
First name
Middlename
Surname
Previous surname
Current Address
Post Code
Sex / M/F / M/F
Date of Birth
Telephone numbers - Home
Work
Mobile
Email address
Relationship to other applicant
Employment status
Tax Rate
Do you have any dependants
Dependants details
Date moved into your current address
Current residential status

APPLICANT DETAILS cont.

If renting, how much do you pay? / £ per / £ per
Are you leaving rental accommodation when new mortgage completes?
Are you on the electoral roll there?
Previous address if less than 3 years (Detail other addresses on separate page if necessary)

HEALTH DETAILS

1st Applicant / 2nd Applicant
Have you smoked in the last 12 months
Are you in good health?

EMPLOYMENT DETAILS

MAIN EMPLOYMENT DETAILS

1st Applicant / 2nd Applicant
Main Employment Status (Employed/Self Employed/ Retired/Not Employed)
Occupation / Job Title
Basis of employment
Employer Name / Name of Business
Type of business
Works / Staff No.
Start date
Date business established /holding acquired
Business status
Company registration no.
Percentage stake in business
Are you a sub contractor
Primary Contractor Name
On probation?
Probation end date
Date started working on a contract basis
Start date of current contract
When is the contract due to end?
Is the contract likely to be renewed?
Other Information

EMPLOYMENT DETAILS Additional Information.

Your expected retirement age / Years Old / Years Old

ADDITIONAL EMPLOYMENT DETAILS(for second jobs)

1st Applicant / 2nd Applicant
Additional Employment Status (Employed/Self Employed/ Retired/Not Employed)
Occupation / Job Title
Basis of employment
Employer Name / Name of Business
Type of business
Works / Staff No.
Start date
Date business established /holding acquired
Business status
Company registration no.
Percentage stake in business
Are you a sub-contractor
Primary Contractor Name
On probation?
Probation end date
Start date of current contract
When is the contract due to end?
Is the contract likely to be renewed?
Other Information

INCOME DETAILS

1st Applicant / 2nd Applicant
If employed:
Basic salary p.a. / £ / £
Guaranteed additional p.a. (overtime, bonus etc.) / £ / £
Regular additional p.a. (overtime, bonus etc.) / £ / £
Other earned income (please specify) / £ / £
If self-employed:
Number of years accounts available / Years / Years
Net profit last year / £ / £
Previous year / £ / £
Year before that / £ / £
Amount of any other income p.a. / £ / £
Details of where other income is from
(e.g. pensions, rental, investment, state benefits, allowances)

INCOME DETAILS cont.

Total Annual Income / £ / £
Net Monthly Take Home pay (TI) / £ / £
Budget available to meet Insurance needs / £ / £

FINANCIAL COMMITMENTS (including current mortgage payments)

Please provide further details in notes if necessary

1st Applicant / 2nd Applicant / Joint
Total Monthly Liabilities (TL) / £ / £ / £

EXISTING PLANS

Life 1 / Life 2 / Joint
Provider
Plan Type / Life/lifecic/IP/Fib / Life/lifecic/IP/ Fib / Life/lifecic/IP/ Fib
Level/DTA/Increasing / Level/DTA/Increasing / Level/DTA/Increasing / Level/DTA/Increasing
Sum assured
Premium
Guaranteed or Reviewable
End Date
Reason for Cover
Life 1 / Life 2 / Joint
Provider
Plan Type / Life/lifecic/IP/Fib / Life/lifecic/IP/ Fib / Life/lifecic/IP/ Fib
Level/DTA/Increasing / Level/DTA/Increasing / Level/DTA/Increasing / Level/DTA/Increasing
Sum assured
Premium
Guaranteed or Reviewable
End Date
Reason for Cover

CURRENT MORTGAGE DETAILS

Lender
Account Number
Owner
Amount of Loan outstanding
Term remaining
Buy-To-Let
Current interest rate
Monthly mortgage payment
To be redeemed
Interest rate type
If ‘other’ give details
If applicable when does the rate end?
Are there any penalties if you transfer or repay your existing mortgage now?
How much is the penalty / £
Early Repayment Charge End Date
If selling, what is the sale price? / £
Are your current mortgage terms portable to a new property?
Repayment method
If Interest Only how do you intend to repay the capital?
If Split: how much is interest only? / £

COVER REQUIRED

1st Applicant / 2nd Applicant
If you or your partner dies, is it important that you protect against the financial consequences of death?
If you or your partner were to suffer a critical illness or permanent disability, is it important to repay your mortgage and other loans?
If you or your partner were unable to work due to illness or accident, is it important to you to be able to pay your mortgage and bills?
Do you or your partner require Private Medical Insurance?
Do you wish to protect your buildings?
Do you wish to protect your contents?
Have you made a will?

LIFE AND CRITICAL ILLNESS PROTECTION

You have indicated that you require Life and CIC cover for applicant 1 and /or 2

1st Applicant

/

2nd Applicant

Who is the cover for?

What is the cover required to protect?

Protection required for?

What level of cover?

Type of cover?

What basis of cover?

Do you want the certainty of knowing the cost of cover does not change throughout the term (Guaranteed Premiums)?

Do you require Waiver of Premium?

Do you require Terminal Illness Benefit?

Do you require Limited Benefits?

Do you require Extended Benefits?

Do you require a buy back option?

Are children CI benefits required?

Do you require Permanent Total disability?

Do you require the contract to be assigned or under trust?

Are there any material facts that should be disclosed relating to medical conditions, claims history etc?

Do you have any existing policies?

INCOME PROTECTION (PHI)

You have indicated that you require Permanent Health Insurance/Accident, Sickness & Unemployment protection for Applicant 1/Applicant 2 if you are unable to work due to illness or accident.
1st Applicant / 2nd Applicant
Who is the protection for?
What level of income would be required £?
Frequency?
Term of Benefit?
If unable to work would you still receive an income?
If yes, how much would you receive? / £ / £
For how long? / Months / Months
What is the source of the Income?
What basis of cover?
If cover required is increasing, by how much? If %, by how much?
Do you want the certainty of knowing the cost of cover does not change throughout the term? (Guaranteed Premiums)
If NO to certainty or premium, do you understand that premiums may increase when they are reviewed?
What deferred period is required?
Do you require waiver of premium?
Hazardous pursuits (including hobbies)?
Are there any material facts that should be disclosed relating to any medical conditions, claims, history etc?
(If yes please refer to notes section)
Do you have any existing Income Protection Policies?

PPI /ASU

You have indicated that you require protection for your mortgage/loans in the event of Accident, Sickness or Unemployment Applicant 1/Applicant 2.
1st Applicant / 2nd Applicant
Who is the protection for?
Is cover required for Accident & Sickness and Or Unemployment?
If unable to work would you still receive an income?
If Yes, how much would you receive? / £ / £
For how long?
What is the source of this income?
What level of benefit is required £?
What deferred period is required?
If joint policy, % split required?
Frequency of payment?
Term of benefit period?
Are there any material facts that should be disclosed relating to any medical conditions, claims, history etc?
(If yes please refer to notes section)
Do you have any existing accident, sickness and unemployment cover in place already?

Notes

Declaration

In order to advise you properly, we must obtain certain information from you about your financial and personal circumstances, to assess your suitability for particular products and services.

Data Protection

I consent to the information you hold about me being processed and held on computer or paper files.

I consent to any information that I give to be disclosed to third parties e.g. credit reference agencies and product providers for the purpose of my application.

I confirm that I have the permission of any other person mentioned to provide any information contained in this document.

I confirm that this declaration has been signed in the UK and that I am a UK resident.

I consent to the data being checked and / or disclosed to the regulatory authorities as part of compliance monitoring activities.

Client Contact

You expressly that I contact you to review your financial arrangements on a frequent basis

YES / NO

I have read this document carefully and confirm that the information is true and accurate.

Advisors Name______

Advisors Signature______

Date______

Applicant 1 Name______

Applicant 1 Signature______

Date______

Applicant 2 Name______

Applicant 2 Signature______

Date______