Insuring your mortgage payments or income

Mortgage Payment Protection Insurance (MPPI) is designed to cover your mortgage payments for a set period should you become unable to work due to an accident, sickness or involuntary unemployment.

Are you interested in finding out more about MPPI?

YES/NO

If you have answered ‘NO’ please briefly say why, then skip to section XXXX.

I am not interested in finding out about MPPI because:

Advised sale wording
If you have answered ‘YES’ please provide answers to the following questions by encircling YES or NO and/or completing requested details where relevant. Your answers will help us decide whether payment protection insurance would be suitable in your particular circumstances.

Non-advised sale wording
If you have answered ‘YES’ please provide answers to the following questions by encircling YES or NO and/or completing requested details where relevant. Your answers will help us to tell you about the details of the cover we can offer and enable you to decide if it gives you the degree of protection you are looking for.

1/ Do you have any existing insurance policies or are you eligible for any company benefits which will pay you an income or lump sum should you be unable to work due to sickness, an or unemployment?

YES/NO

Policy name & company

Start date

End date

Insured event (eg accident, sickness, unemployment)

Amount/frequency payable & for how long

How soon paid after insured event occurs

3a/ Please confirm your employment status:

EMPLOYED/SELF-EMPLOYED

3b/ Do you have any plans to change your job/employment status?

YES/NO

3c/ If the answer above is YES, please give brief details

4a/ Do you have more than one employer?

YES/NO

4b/ If you answered YES above is any of your work of a temporary or seasonal nature?

YES/NO

4c/ Please give your start date for your main employer

4d/ If relevant, please give your start date for any 2nd (non temporary/non-seasonal) job

4e/ Are you aware of redundancy plans at your work?

YES/NO

4f/ If you answered ‘YES’ above, please give brief details

5a/ Please give the month and year you started trading and from which accounts are available

5b/ Do you have any reason to believe that you may be forced to cease trading involuntarily in the future?

YES/NO

5c/ Policies for the self employed are extremely limited. Please tick each item on the right to confirm that you understand them.

Payment protection policies covering the self-employed:

• only pay out if you cease trading involuntarily
• don’t pay out if you know that you’re likely to have to cease trading at the time you take out the insurance
• don’t pay out if you are going through a ‘lean patch’ or have no work
• don’t pay out if you cease trading voluntarily

6/ Do you live in the UK, Channel Islands of Isle of Man for at least 40 weeks a year?

YES/NO

7/ When do you expect to retire?

Year _______ / Not sure

8/ Do you have any plans to move house in the next few years?

YES/NO/NOT SURE

8a/ If you answered YES above, please give expected year of move.

8b/ Do you have any plans to move outside the UK, Channel Islands or Isle of Man in the next few years?

YES/NO

8c/ If the answer above was YES in which year do you think you may move abroad?

9/ Do you plan to remortgage (change mortgages) in the next few years?

YES/NO/NOT SURE

10/ Do you expect to be able to repay your mortgage in full in the next few years?

YES/NO/NOT SURE

10a/ If you answered YES above, in which year do you expect to be able to repay the mortgage?

11 Are you currently off work due to ill health?

YES/NO

11a/ Do you have any existing medical conditions, or do you suffer from chronic illnesses (including anxiety/stress or back pain) that affect your ability to work?

YES/NO

11b/ If you answered ‘YES’ above, please give brief details.

12/ Have you previously claimed insurance to cover your income or mortgage repayments?

YES/NO

12a/ If you answered YES above, please give brief details including the nature, date and period of the claim.