Annuity Enquiry Form - Moneyworld

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Annuity enquiry form

Your name
Title*
First name*
Surname*
Gender*
- Male
- Female
Date of birth*
Date Format: DD slash MM slash YYYY
Occupation
Contact details
Telephone number
Email*
Enter Email Confirm Email
Address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Annuity requirements
Total fund value*
Source of funds*
How much tax free cash do you require*
Please enter a number from 0% to 25%.
Please enter an amount between 0% and 25% (maximum tax free cash is 25%)
Payment frequency*
Level or increasing income*
Guarantee period*
Spouses pension
Would you like a pension paid to your spouse in the event of your death?*
- Yes
- No
If yes what percentage of the income from your annuity would you like paid to your spouse?
Please enter an amount between 1% and 100% (if you have chosen a spouses pension)
Your spouses date of birth
Date Format: DD slash MM slash YYYY

This is only needed if you have chosen to include a spouses pension
Medical details
Are you a smoker?*
- Yes
- No
If yes please state how many cigarettes and/or how much rolling tobacco you smoke per week
If you are a smoker please confirm how many years you have smoked for
Do you suffer from any medical conditions? (this information can help us obtain enhanced rates)*
- Yes
- No
If yes please give further information below
We may contact you to ask for further information. This helps us get accurate quotes.
Does your spouse have any medical conditions? (only applicable if you have chosen a spouses pension)
- Yes
- No
If yes please give your spouses medical information here
We may contact you to ask for further information. This helps us to get accurate quotes.
Name
This field is for validation purposes and should be left unchanged.

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