This page is for UK financial advisers. If you're a customer, please go to the main site.

Download the form

You can view the entire form by clicking Download form. An accompanying guide to the form is also available to download. This guide provides information on completing the form.

Download form Download guide

Form builder

In order to only include the pages of the form that are relevant to your client, please select your client's and their dependant’s medical conditions below, then click Download form. An accompanying guide to the form is also available to download. This guide provides information on completing the form.

Heart attack, angina and other vascular conditions
Diabetes
Cancer, leukaemia, lymphoma, growth or tumour
How many types/occurrences of cancer, leukaemia, lymphoma, growth or tumour do you need to include?
Stroke
Respiratory/lung disease
Multiple sclerosis
Other neurological condition
Other conditions
How many other conditions do you need to include?
Download guide

How to get a quote

Once you have completed the form with your client, you can use this information to obtain a bespoke annuity quote using one of the third-party portal providers below.

Alternatively, you can capture the information directly on one of the portals. Each portal will search the whole of market to ensure your client receives the best rate available at that time from all participating providers. By using one of the portals detailed below, once you have input all the client details, you could receive a fully underwritten and guaranteed quote in as little as 15 seconds.

Ams

Web: amsretirement.co.uk
Free to use

iPipeline

Web: uk.ipipeline.com/products/assureweb-annuities
Free to use

Iress: The Exchange

Web: exweb.exchange.uk.com/public/login
Charge to use

Synaptic

Web: www.synaptic.co.uk/solutions/webline
Charge to use

Alternatively you can email the completed form to the participating providers but it may take longer to receive your annuity quotes. Please note that not all providers can provide quotes via email and we cannot guarantee that we will receive any email you send us, or that it will not be intercepted by someone else. For those reasons, you should always protect any personal information you share with an insurer by email.

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