Please complete the form below and your annuity quotation
will be emailed to you. Quotes are available to UK citizens only
All
information is submitted in strict confidence and you are never under any obligation to
proceed.
The impaired or enhanced annuity quotes we provide do not
represent personalised advice and are not a recommendation that any product matches your circumstances. If
you should have any doubts please contact an independent financial adviser so that your individual
circumstances can be considered.
Your
Details
Your Full Name
Address
Telephone Number
Email Address
Date of Birth dd/mm/yyyy
Do you smoke
Yes
No
If yes, type of tobacco smoked
How long have you smoked
Amount smoked per day
Height
Weight
Marital Status
Occupation
Full time
Part time
Previous Occupation if no
longer working
Summary of your Medical
Conditions
CONDITION 1
Date Diagnosed
Any Specialist
Investigation
Treatment and Medications Taken including
Daily Dosages.
CONDITION 2
Date Diagnosed
Any Specialist Investigation
Treatment and Medications Taken
including Daily Dosages.
CONDITION 3
Date Diagnosed
Any Specialist Investigation
Treatment and Medications Taken
including Daily Dosages.
Spouse Details - For
Joint Applications
Spouse Full Name
Address
Date of Birth dd/mm/yyyy
Do you smoke
Yes
No
If yes, type of tobacco smoked
How long have you smoked
Amount smoked per day
Height
Weight
Occupation
Previous Occupation if no
longer working
Summary of Spouses Medical
Conditions
CONDITION 1
Date Diagnosed
Any Specialist
Investigation
Treatment and Medications Taken
including Daily Dosages.
CONDITION 2
Date Diagnosed
Any Specialist Investigation
Treatment and Medications Taken
including Daily Dosages.
CONDITION 3
Date Diagnosed
Any Specialist Investigation
Treatment and Medications Taken
including Daily Dosages.
Pension Annuity
Details (using funds from a pension plan)
Total amount of Pension Fund
after deduction of Tax Free Cash lump sum if applicable
Total amount of any
'Protected Rights' benefits?
Does this pension provide a
'Guaranteed Annuity Rate'?
Original source of pension
fund
Do you require your Annuity
to escalate
Do you require the Annuity
to have a Minimum Guranteed Period
If you require a spouses
pension, what amount do you require to be paid to your spouse on your death?
Please ensure spouses details are completed above.
Purchased Life Annuity
Details (using your own funds)
Purchased Life Annuities and
Immediate Needs Annuities, Lump Sum Available
Do you require your Annuity
to escalate
Do you require the Annuity
to have a Minimum Guranteed Period
Joint life plans only: if
you require a spouses pension, what amount do you require to be paid to your
spouse on your death
Please note:
Escalating annuities,
Guarantee periods and joint life annuities will result in lower initial
annuity income when compared to level, single life annuities with no
guarantee.
Any Other
Comments
Data Protection Act 1998: By sending this
illustration request you consent to the above medical information being used by our annuity
providers for the purpose of providing you with an annuity quotation without cost or
obligation. Your details are protected by the Data Protection Act and will only be used to
complete your annuity quotation.
Or print off and send by post to:
Biggerpensions.com
Eckington Business Centre
62 Market Street, Eckingtion
Derbyshire
S21 4JH
Biggerpensions.com is a trading name of Clarity Financial
Advice Ltd. Registered in England and Wales No 5615986. Registered Office: Eckington Business
Centre, 62 Market Street, Eckington, Derbyshire S21 4JH. Clarity Financial Advice Ltd is
Authorised and Regulated by the Financial Services Authority.
The guidance and/or information contained within this web site is
subject to the UK regulatory regime and is therefore primarily restricted to consumers based in
the United Kingdom.
