Life Insurance Personal Details

All fields marked with a

must be filled in

First Applicant Details

What is the 1st applicant's sex

What is the 1st applicant's date of birth?

Has the 1st app. smoked in the last 12 months?

Second Applicant Details

What is the 2nd applicant's sex?

What is the 2nd applicant's date of birth?

Has the 2nd app. smoked in the last 12 months?

Policy Details

Policy type

Waiver of premium

Amount of life or critical illness cover £

Policy Term

Please enter your current postcode

Please enter your contact details so we can e-mail your quotation to you and assist you with your application.

E-mail address

Home phone number

Need more help?

Sales Support and Service Number
0844 871 1340

General enquiries
0844 871 1341

Protect your bubble life insurance and income protection is provided and administered by Direct Life & Pension Services Ltd, who are authorised and regulated by the Financial Services Authority. Registered Office; Pinnacle House, A1 Barnet Way, Borehamwood, Hertfordshire WD6 2XX. Registration number 2467691.

Calls to 0844 numbers cost 5p per minute from a BT landline. Calls from other networks may vary and calls from mobile phones could be considerably higher.

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Protect your bubble is a trading name of Assurant Direct Limited (Company No. 5399683); an Appointed Representative of Assurant Intermediary Limited (Company No. 4019801). Assurant Intermediary Limited is authorised and regulated by the Financial Services Authority (Registered No. 311243). Assurant Direct Limited and Assurant Intermediary Limited are subsidiaries of Assurant Group Limited (Company No. 3264846). VAT No. 577650307. All companies are registered in England and Wales.

Protect your bubble life insurance and income protection is provided and administered by Direct Life & Pension Services Ltd, who are authorised and regulated by the Financial Services Authority. Registered Office; Pinnacle House, A1 Barnet Way, Borehamwood, Hertfordshire WD6 2XX. Registration number 2467691.

Direct Life & Pension Services Ltd may record telephone calls for quality assurance purposes.