Cash Out Life Policy

Online Submission

Submitting the details online should take no more than 5-7 minutes. Fields marked* are compulsory. For all other fields, please complete as best as you can or leave blank. If you'd prefer we obtain the information directly from the life company please Contact Us Here
Contact Details
Adviser Name*
First* Last*
Adviser Email*
Adviser Phone Number

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Policyholder Details
How many policyholders are there*
- 1
- 2
- 3
Policyholder*
First Names* Last Name*
Second Policyholder*
First Names* Last Name*
Third Policyholder*
First Names* Last Name*
Policyholder Address*
Street or Rural Address* City/Town or Area* Postcode Country*
Life Insured Name and Date of Birth
Is the policy jointly insured?
- Yes
- No
Name of Life Insured*
First Names* Last Name*
Date of Birth*
Date Format: DD slash MM slash YYYY
Name - second insured party*
First Names* Last Name*
Date of Birth second insured party*
Date Format: DD slash MM slash YYYY
Policy Details
If there is more than one policy to sell, simply load data for the first policy then click the box at the end to load further inputs
Policy Number*
Life Insurance Company ( choose from drop-down box )*
Please advise name of life company
Is it a whole of life or endowment policy?
Policy Maturity Date*
Date Format: DD slash MM slash YYYY
Policy Start Date
Date Format: DD slash MM slash YYYY
Sum Insured
Total annual or guaranteed bonuses
Gross surrender value (or gross cash value) quoted by life company*
Value of any premium or loan debts quoted by life company (if any)*
Net surrender value (or net cash value) quoted by life company (the value after deducting any premium debts or loans against the policy)*
Enter own surrender value?
- yes
Other Net Surrender Value
Premium Amount
Premium Frequency
Add another policy
- Yes
Policy Two Details
Policy Number*
Life Insurance Company ( choose from drop-down box )*
Please advise name of life company
Is it a whole of life or endowment policy?
Policy Maturity Date*
Date Format: MM slash DD slash YYYY
Policy Start Date
Date Format: DD slash MM slash YYYY
Sum Insured
Total annual or guaranteed bonuses
Gross surrender value (or gross cash value) quote by life company
Value of any premium or loan debts quoted by life company (if any)
Net surrender value (or net cash value) quoted by life company (the value after deducting any premium debts or loans against the policy)
Enter own surrender value?
- yes
Other Net Surrender Value
Premium Amount
Premium Frequency
Add Another Policy
- Yes
Policy Three Details
Policy Number*
Life Insurance Company ( choose from drop-down box )*
Please advise name of life company
Is it a whole of life or endowment policy?*
Policy Maturity Date*
Date Format: MM slash DD slash YYYY
Policy Start Date
Date Format: DD slash MM slash YYYY
Sum Insured
Total annual or guaranteed bonuses
Gross surrender value (or gross cash value) quote by life company
Value of any premium or loan debts quoted by life company (if any)
Net surrender value (or net cash value) quoted by life company (the value after deducting any premium debts or loans against the policy)
Enter own surrender value?
- yes
Other Net Surrender Value
Premium Amount
Premium Frequency
Add Another Policy
- Yes
Policy Four Details
Policy Number*
Life Insurance Company ( choose from drop-down box )*
Please advise name of life company
Is it a whole of life or endowment policy?
Policy Maturity Date
Date Format: MM slash DD slash YYYY
Policy Start Date
Date Format: DD slash MM slash YYYY
Sum Insured
Total annual or guaranteed bonuses
Gross surrender value (or gross cash value) quote by life company
Value of any premium or loan debts quoted by life company (if any)
Net surrender value (or net cash value) quoted by life company (the value after deducting any premium debts or loans against the policy)
Enter own surrender value?
- yes
Other Net Surrender Value
Premium Amount
Premium Frequency
Add Another Policy
- Yes
Policy Five Details
Policy Number*
Life Insurance Company ( choose from drop-down box )*
Please advise name of life company
Is it a whole of life or endowment policy?
Policy Maturity Date
Date Format: DD slash MM slash YYYY
Policy Start Date
Date Format: DD slash MM slash YYYY
Sum Insured
Total annual or guaranteed bonuses
Gross surrender value (or gross cash value) quote by life company
Value of any premium or loan debts quoted by life company (if any)
Net surrender value (or net cash value) quoted by life company (the value after deducting any premium debts or loans against the policy)
Enter own surrender value?
- yes
Other Net Surrender Value
Premium Amount
Premium Frequency

Save and Continue Later

Other Information
Where did you hear about us?*
Other
Which option would you like us to quote on?*
Consent*
I agree

Save and Continue Later

Step 1 of 3

Online Submission

Contact Details

Policyholder Details

Life Insured Name and Date of Birth

Policy Details

Policy Two Details

Policy Three Details

Policy Four Details

Policy Five Details

Other Information