0345 216 0002
Contact Us
Relevant Life Insurance
Please fill in a valid value for all required fields
Please ensure all values are in a proper format.
Are you sure you want to leave this form and resume later?
Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.
Save and Resume Later
Save and get link
You must upload one of the following file types for the selected field:
There was an error displaying the form. Please copy and paste the embed code again.
Apply Discount
You saved
with code
Get Your Quote
Submitting
Validating
There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.
Please check the field:
Hello, Let's Get Your Relevant Life Insurance Sorted Out
Get a Vitality life insurance quote with an Apple Watch and other major rewards
We will also give you a comparison quote from all of the UK's biggest insurers
Save nearly 50% in tax compared to an ordinary life policy
FREE expert insurance advice
Are you a Director or employee of a limited company?
Yes
No
What would you like to cover?
My Family
My Mortgage
Family & Mortgage
Have you smoked or used nicotine replacements in the last 12 months?
Yes
No
How much cover do you want?
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
550,000
600,000
650,000
700,000
750,000
800,000
850,000
900,000
950,000
1,000,000
1,050,000
1,100,000
1,150,000
1,200,000
1,250,000
1,300,000
1,350,000
1,400,000
1,450,000
1,500,000
1,550,000
1,600,000
1,650,000
1,700,000
1,750,000
1,800,000
1,850,000
1,900,000
1,950,000
2,000,000
2,050,000
2,100,000
2,150,000
2,200,000
2,250,000
2,300,000
2,350,000
2,400,000
2,450,000
2,500,000
2,550,000
2,600,000
2,650,000
2,700,000
2,750,000
2,800,000
2,850,000
2,900,000
2,950,000
3,000,000
3,050,000
3,100,000
3,150,000
3,200,000
3,250,000
3,300,000
3,350,000
3,400,000
3,450,000
3,500,000
3,550,000
3,600,000
3,650,000
3,700,000
3,750,000
3,800,000
3,850,000
3,900,000
3,950,000
4,000,000
4,050,000
4,100,000
4,150,000
4,200,000
4,250,000
4,300,000
4,350,000
4,400,000
4,450,000
4,500,000
4,550,000
4,600,000
4,650,000
4,700,000
4,750,000
4,800,000
4,850,000
4,900,000
4,950,000
5,000,000
How long do you want cover for?
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12 Years
13 Years
14 Years
15 Years
16 Years
17 Years
18 Years
19 Years
20 Years
21 Years
22 Years
23 Years
24 Years
25 Years
26 Years
27 Years
28 Years
29 Years
30 Years
31 Years
32 Years
33 Years
34 Years
35 Years
36 Years
37 Years
38 Years
39 Years
40 Years
Date of birth
https://www.formstack.com/forms/images/2/calendar.png
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
What is your gender?
Male
Female
Title
*
Mr
Miss
Mrs
Ms
Dr
First Name
*
Last Name
*
Street Address
City
Postcode
Phone Number
*
Email Address
*
Partner's Title
Mr
Miss
Mrs
Ms
Dr
Partner's First Name
Partner's Last Name
Has your partner smoked or used nicotine replacements in the last 12 months?
Yes
No
Partner's date of birth
https://www.formstack.com/forms/images/2/calendar.png
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
What is your partner's gender?
Male
Female
Any Known Medical Conditions?
We also provide mortgage advice. Would you like help with your mortgage?
Yes Please
No Thank You
Keep me up to date with iam insured's fantastic offers. If you don't want to receive these offers, just unsubscribe with 1 click!
Yes Please
No Thank You
Previous
←
Next
→
Enter your save and resume password
Cancel
Confirm