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What type of policy do you need?
Life insurance
Mortgage life insurance
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Who is the cover for?
Just for you
For you and someone else
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How much cover do you need?
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How long do you need your policy to last?
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Title
Mr
Mrs
Ms
Miss
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First name
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Last name
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Are you a smoker?
Yes
Ex
No
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Number of whole years since given up smoking?
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Date of birth
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Partner's title
Mr
Mrs
Ms
Miss
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Partner's first name
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Partner's last name
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Partner's date of birth
Day
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Month
1
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Year
2005
2004
2003
2002
2001
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1998
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1992
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1956
1955
1954
1953
1952
1951
1950
1949
1948
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1946
1945
1944
1943
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Is your partner a smoker?
Yes
Ex
No
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Number of whole years since they gave up smoking?
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