Life Cover Enquiry

Please fill in the following form if you require a life insurance quote from Alba Mortgage Solutions. We will get back to you as soon as possible by email or if preferred, telephone.

Please fill in this form for a Life Cover quote.

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Name:*

Email:*

Type of cover*

Life Cover Life or Critical Illness Cover Life or Serious Illness Cover Whole of Life Cover Income Protection

Address*

Postcode*

Occupation*

Smoker*

Yes No

Amount of cover required £*

Number of years cover is required*

Telephone Number

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FOR INCOME PROTECTION ONLY

Gross annual earnings

Monthly income required

Income to be paid following (months)

1 3 6 12

Number of years cover required

Current or proposed monthly mortgage payment £

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FOR ACCIDENT, SICKNESS AND UNEMPLOYMENT COVER ONLY

Type of cover -

Accident+Sickness+Unemployment Accident+Sickness only

Monthly benefit required

Benefit period

12 months 24 months

Benefit period following

30 days 60 days 90 days

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Privacy notice*

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