Purchase Life Annuity Quotations

Please note that a Purchase Life Annuity is funded from your personal savings, as opposed to a pension fund. This form is a single page, however a medical questionnaire will follow if the Impaired Life option is selected.

Section 1: Annuity & Personal Details
Single / Joint Life:		Single    Joint
Amount of contribution		£
Indexation		Level3%5%
Guarantee Period		None5 years10 years
Frequency of income payments		MonthlyQuarterlySix MonthlyYearly
Spouse's Benefit		None33%50%66%100%
Impaired Life		NoAnnuitantSpouseBoth
		Your details		Your dependant's details
Title		MrMrsMissMsOther		MrMrsMissMsOther
If 'other' please specify
Gender		MaleFemale		MaleFemale
Surname
Forename(s)
Date of birth		(dd/mm/yyyy)		(dd/mm/yyyy)
Smoker Status		YesNoNever		YesNoNever
Marital Status		SingleMarried/Civil PartnershipSeparatedDivorcedWidowed		SingleMarried/Civil PartnershipSeparatedDivorcedWidowed
Postcode
E-mail address