Life Insurance Quote

Fill in your details in the form below for a personalised Life Insurance Quote. It only takes a moment. SMP Mortgages can provide a more detailed quote based on the information provided - completing all three stages allows for a more comprehensive assessment.

Type of Application	Single Joint
Title	ChooseMrMissMrsMs
First Name
Last Name
DOB	Day
	Choose12334568910111213141516171819202122232425262728293031
	Month
	ChooseJanFebMarAprMayJunJulAugSepOctNovDec
	Year
	Choose1930193119321933193419351936193719381939194019411942194319451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000
Title 2	ChooseMrMissMrsMs
Client 2 - First Name
Client 2 - Last Name
DOB 2	Day
	Choose12334568910111213141516171819202122232425262728293031
	Month
	ChooseJanFebMarAprMayJunJulAugSepOctNovDec
	Year
	Choose1930193119321933193419351936193719381939194019411942194319451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000
Address
Postcode
Day Phone Number
Evening Phone Number
Email
Client 1 Smoked in the last 12 months	ChooseYesNo
Client 2 Smoked in the last 12 months	ChooseYesNo
Mortgage Protection
How much cover do you want
Term
or
How much do you want to pay?	£
Per	Chooseweekmonthyear
Term
Critical Illness
How much cover do you want?
or
How much do you want to pay?	£
Per	Chooseweekmonthyear
Term
Term Assurance	ChooseDecreasing Term AssuranceLevel Term Assurance
I have read, understood and agree to the Data Protection Declaration	ChooseYesNo
I agree to further contact as described below in Our Future Relationship	ChooseYesNo

Data Protection Declaration

SMP Mortgage and Loans Ltd and Home of Choice Ltd will process all information in accordance with the Data Protection Act 1998 and it will be treated as private and confidential now and in the future. The only exceptions to this will be when the law requires us to disclose information or, with your consent, where disclosure is necessary when arranging or servicing your mortgage or protection contracts.

To fulfill our regulatory obligations, we will retain copies of your records for no longer than is necessary or for the duration of any contract you may enter into. You have the right to inspect these records at any time.

Our Future Relationship

Our ongoing business relationship with you is important and we would like to be able to contact you by telephone, post or email from time to time to review your mortgage and associated protection product arrangements and introduce other services that may be of interest to you from ourselves or our associated companies.

SMP Mortgages & Loans Ltd are an appointed Representative of Home of Choice Ltd. Which is authorised and regulated by the Financial Services Authority.