Illness

A bit about yourself...

First Name

Last Name

Phone Number

Date of Birth

Have you used a nicotine-based product in the last 12 months?

How much do you want covered?

In Total

Term Length (Years)

Would you like to add another person to this policy?

A bit about the second person...

Date of Birth

Has this person used a nicotine-based product in the last 12 months?

How much do they want covered?

In Total

Term Length (Years)

How would you like the policy to payout?

I understand that FitzGerald Flynn Insurances Ltd. will use the contact details provided above to offer advice and if I agree, to begin the process of entering into a contract of insurance. Details of your rights with regard to personal data are contained in our Terms of Business.

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Terms & Conditions apply to all insurance quotes. A signed declaration and/or a medical review by the insurance underwriter may be needed before any cover is put in place.

Life Insurance

Standalone Illness

A bit about yourself...

How much do you want covered?

A bit about the second person...

How much do they want covered?

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