PROTECTION QUOTATION FORM    [help]   Fields marked with an asterisk are compulsory. : *full name : address &. phone : *contact telephone : e-mail address select basis of life cover :   single life   joint lives client 1 *sex : male    female    *date of birth :  *occupation  :   *smoker? :   yes    no client 2 (if you have selected joint lives above) sex : male    female    date of birth :  occupation  :   smoker? :   yes    no   *Product Type : Mortgage Life cover Mortgage Life cover/Critical Illness Benefit Accident/Sickness/Unemployment cover Family Protection Income Protection Family Income benefit Whole of Life cover Inheritance Tax Planning Benefit Type : Death Benefit only Critical Illness Cover Death Benefit with Critical Illness Cover Monthly Yearly : Premium frequency : *Term in Years : Required Benefit Amount Waiver of premium? : yes    no   If you have any problems completing or sending this form, please e-mail us (or call us on the numbers shown below).   The information collected will be used solely for the purposes of providing background information when contacting you to arrange an appointment.     Your home may be repossessed if you do not keep up repayments on your mortgage.   Nowadays, people have many more financial commitments than previous generations. So the need to protect your lifestyle and provide for your loved ones, if the unexpected should happen, is greater than ever before. With Greenlight Mortgages you can request quotations for life assurance on-line. You should be aware that in so doing you will not receive personalised advice nor does the product or level of cover match your financial requirement. OR You may opt for personal guidance by submitting to a complete financial health check. On receipt of all your relevant personal and financial details we will be able to prepare a plan tailored to your individual circumstances.   Please complete the Protection Quotation Form for an initial quote. If you have any queries, please do not hesitate to call us at: (028) 9060 4448. OR Fax us on: (028) 9060 4503   Greenlight Mortgages is an appointed representative of Intrinsic Mortgage Planning Limited, which is authorised and regulated by the Financial Services Authority. Intrinsic Mortgage Planning Limited is entered on the FSA register (http://www.fsa.gov.uk/register/) under reference 440718. Greenlight Mortgages, 535 Falls Road, Belfast, BT11 9AA Tel: 028 9060 4448 Fax: 028 9060 4503 e-mail: info@greenlightmortgages.com