Freelancer Income Protection

PHI Finder

Permanent Health Insurance (PHI) "Finder"

Your Name [Required]
Your Email Address [Required]
Phone Number
Mobile Number:
Sex	Male Female
Do you smoke?	Yes No
Date of Birth
Benefit Level Required (per month)
Expected retirement age
Age benefit required to (if different)
Waiting/Deferred Period
Inflation Proofing at
Would you like details of 1 day deferred cover?	Yes No
Who will pay the premium?	Company Freelancer
Is the benefit required under 50% of your taxable income?	Yes No
Do you split dividends with another shareholder?	Yes No
Comments
Freelancer Money will respect your privacy and adhere to the Data Protection rules as outlined in our Private Client Agreement.