Helping to secure your family against the loss of your potential income If you do not have dependant children this plan is not for you, please contact us directly for advice Calculator Your DetailsName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of Birth* DD slash MM slash YYYY Email Address for contact* Mobile Number for contact*Number of dependent children aged under 25*Please enter a number from 0 to 50.Age of your youngest child*Please enter a number from 0 to 24.IncomeEmployment status*EmployedSelf-employedWorking in the homeUnemployedRetiredOccupation* Net monthly income*Please enter a number from 0 to 99999.From all sources such as employment, rental income etc. (after deductions such as tax and social insurance)OutgoingsAccomodation* Mortgage Renting Monthly Mortgage Repayments?*Please enter a number from 0 to 99999.Years left on mortgage?*Please enter a number from 0 to 100.Rent*Please enter a number from 0 to 99999.How much are you paying on rent on your family home?Smoking habits*Non-smokerOccassional smokerUse nicotine replacement or e-cigarettesRelationship Status* Single Co-habiting Married Your Partner's DetailsName* First Last Date of Birth* DD slash MM slash YYYY Employment status*EmployedSelf-employedWorking in the homeUnemployedRetiredOccupation* Net monthly income*Please enter a number from 0 to 99999.From all sources such as employment, rental income etc. (after deductions such as tax and social insurance)Smoking habits*Non-smokerOccassional smokerUse nicotine replacement or e-cigarettesConclusionNumber of years of salary coveredInitial amount of cover for youInitial amount of cover for your partnerThe amount needed to cover essential bills if you become too ill to work YouYour PartnerTotal Bill CoverYears of essential bill cover*This is not a quote, we will contact you soon to refine your needs.CommentsThis field is for validation purposes and should be left unchanged.