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Forms

  • Protect Data Capture Form

    This form can be used to apply online with Protect Quote and Apply or as a postal aplication. 

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  • Applying for additional Protect policies

    This form should be used with the applying for Protect application form if you want more than four policies.

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  • Applying for Protect with tele-interviewing - Access to medical reports form

    This form is used to seek permission from the person(s) insured to access their medical records, in support of their application. 

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  • Applying for Protect with tele-interviewing

    This form can be used as a data capture form for online or postal applications.

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  • Applying for Protect with tele-interviewing - Declaration and application

    This declaration is to accompany the 'Applying for Protect with tele-interviewing' form.

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  • Protect Direct Debit

    Use this form for direct debit instructions in support of an application.

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  • Applying for Protect continuing cover

    Application form to be used when applying for Protect continuing cover. Applicable to joint life first death fixed or rolling term policies only.

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  • Additional health information

    Use this form as a supplement to an application form for Protect or The Skandia Plan when more than four additional questions need to be answered.

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  • Applying for Protect after-claim cover 1

    Application form to be used when applying for Protect after-claim cover following a critical illness claim for cancer.

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  • Applying for Protect after-claim cover 2

    Application form to be used when applying for Protect after-claim cover following a claim other than cancer.

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  • Commission selection form for Protect

    This form is to be completed to opt for a lower level of initial commission on a Protect policy.

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  • Comprehensive declaration of health

    To be used for all non standard increases (increases over and above the standard inflation option) and reinstatements (recommencing a paid up policy) for both life and pensions, also in new business cases where existing evidence is out of date and new evidence may be required.

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  • Declaration of continuing good health

    For new business only, to be used when applications and acceptance of terms are out of date, this form is used to provide Old Mutual Wealth with confirmation of a change in the client's health since the application was originally dated or the underwriting decision was made.

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  • Immediate cover facility for business protection

    This form is to be completed to apply for immediate cover with business assurance and key employee applications with a Protect policy.

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  • Immediate cover facility for Inheritance Tax (IHT) planning

    This form is to be completed to apply for immediate cover with a Protect policy.

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Financial Adviser Verification