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Contact Details
Title:
*Full Name:
Address:
Post Code:
*Telephone Number:
Preferred Time To Call:
*Email Address:
Financial Details
Main Occupation During Working Life:
Fund Size (Approx):
Pension Type:
Annuity Basis:
Guarantee:
Escalation Basis:
Tax Free Cash (TFC):
Other TFC Amount:
Retirement Date:
Applicant Details
Date Of Birth:
Gender:
Are you currently a smoker and have been for the last 10 years?:
If yes please advise average daily consumption:
Number of Cigarettes:
Number of Cigars:
Oz's of Pipe Tobacco:
Oz's of Cigarette Tobacco:
Height:	Feet inches or metres
Weight:	stones pounds or kilograms
How many units of alcohol do you drink each week?
Do you suffer from High Blood Pressure?
If yes please advise BP readings POST medication if known
If yes please advise number of medications taken daily for BP
Do you suffer from High Cholesterol?:
If yes please advise Cholesterol level POST medication if known:
If yes please advise number of medications taken daily for High Cholesterol:
Do you suffer from Diabetes?:
If yes when were you diagnosed with diabetes?:
If yes please advise what type of diabetes you have:
How often do you monitor your blood glucose levels?:
If insulin dependant how many times daily do you take insulin?:
Relating to your diabetes do you have any of the following complications?:
Any Other Health or Medical Conditions:
Spouse/partner details
In the event of your death, do you want your pension payable to your spouse/partner:
Spouse/partner date of birth:
Main Occupation During Working Life:
Smoker?:
If yes, how many per day:
Any Health or Medical Conditions:
Would you like info on Pension Drawdown or Phased Retirement?:
Do you require any information regarding equity release?:
Any Other Information:
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As a leading annuity advisor, we are best placed to offer the best annuity quotes. Our independent position in the market allows us to source the best annuity quotes from the open market which means that we can find you the best annuity rates from a wide range of annuity providers from the whole annuity market.

We can offer a no obligation annuity quote based on your individual circumstances so the annuity quotes you receive will be formed using a range of information including age, health, pension fund as well as a range of other information.

Get a free annuity quote today and one of our expert annuity advisors can start sourcing the rates for you.

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