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1.  Is this cover just for you, or for you and your partner? Single - If your mortgage was taken out in one persons name only then you should select single. If your mortgage was taken out by you and your partner then you should select joint.
2. 

Personal Details

You

Your partner
   Name
   Surname
   Date of birth (dd/mm/yyyy) / /19 / /19
   Are you...? Male Female Male Female
   Have you used tobacco products in the last 12 months?  Yes No Yes No
 
3.  What type of mortgage do you have?
For a repayment mortgage, your cover would decrease as your mortgage goes down. 90% of mortgages are repayment mortgages.
For an interest only mortgage your cover would remain level.
 
4.  How much...? I would like € of cover This amount is the amount you are borrowing or the amount presently outstanding on your loan
5.  How long do you want to be insured for? years This is the same as your loan e.g. 20 years. If you are replacing an existing policy then the term on the policy must match the remaining term on your loan rounded up a year. E.g. a loan with 15 years 7 months to go would need a 16 year policy
6.  Email
Please send me details of LABrokers products including any special offers   
I have read and agree to the terms and conditions.