Business Assurance

We undertake a business assurance needs analysis to identify specific needs. This could be in the form of sinking funds, key man assurance and partnership assurance.

Life Assurance

Life assurance is a financial product that protects your loved ones, giving you and your family peace of mind. Long term assurance covers a fairly diverse range of products.

Life Application Information request

Life Application Form

1. Personal Details


Period of Cover


2.Complete on behalf of any person requiring life cover

Underwriting requirements


Duty Split


Cover required


Chronic Cover


PMB Chronic Diseases List (CDL)

Tick where applicable


YesNo
1. Addison’s disease
2. Asthma
3. Bipolar mood disorder
4. Bronchiectasis
5. Cardiac failure
6. Cardiomyopathy
7. Chronic obstructive pulmonary disease (COPD)
8. Chronic renal disease
9. Coronary artery disease
10. Crohn’s disease
11. Diabetes insipidus
12. Diabetes mellitus type 1
13. Diabetes mellitus type 2
14. Dysrhythmia
15. Epilepsy
16. Glaucoma
17. Haemophilia A and B
18. HIV
19. Hyperlipidaemia
20. Hypertension
21. Hypothyroidism
22. Multiple sclerosis
23. Parkinson’s disease
24. Rheumatoid arthritis
25. Schizophrenia
26. Systemic lupus erythematosus (SLE)
27. Ulcerative colitis
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