Tel: 0844 579 1008


Covering climbers for over 20 years

life insurance services for mountaineers and climbers

Life Insurance specialists for MC of SWe are a trusted membership benefit of the British Mountaineering Council and Mountaineering Scotland

Title*
Forename
Middle Names
Surname
Address
Address 2
Town
County
Postcode
Tel (Day)*
Tel (Eve)
E-mail:
Date of Birth
 / 
 / 
Marital Status
Occupation
Do you smoke?*
Do you wish to include a second person on this quote?
Title(2)
Forename(2)
Middle Names(2)
Surname(2)
Address(2)
Address 2(2)
Town(2)
County(2)
Postcode(2)
Tel (Day)(2)
Tel (Eve) (2)
Email(2)
Date of Birth(2)*
 / 
 / 
Marital Status(2)
Occupation(2)
Do you smoke?(2)*
Please select any of the following:
Mortgage Protection
Family Protection
Income Protection
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Details of the Mortgage / Family Protection Policy Required

Persons Covered
Term of Policy (Enter between 10 and 40 years)

Amount of Life / Critical Illness Insurance:

Decreasing (For repayment mortgages: cover decreases through contract)
Level (Constant cover throughout the contract)
Do you want Critical Illness Cover?

Details of the Income Protection Policy Required

Client A :

Annual Gross Income £
Amount of Cover / month (or 'quote maximum') £
Deferred Period

(eg. If your employer pays sick pay for 26 weeks, then you should choose the 26 week option).

Expiry Age
Optional Day-One Accident cover (only if you receive no company sick pay)

Client B:

Annual Gross Income (2) £
Amount of Cover / month (or 'quote maximum') (2) £
Deferred Period (2)
Expiry Age(2)
Optional Day-One Accident cover (only if you receive no company sick pay) (2)
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Climbing Details

Are you a BMC Member?
Are you a Mountaineering Scotland member?
Are you a Club Membership?
How long have you been climbing?
What best describes your climbing? (Select your highest level of participation)
What grade do you climb to?
Where do you climb?
Max Altitude that you climb/mountaineer at
Where do you climb outside the UK? (Please give geographical locations and ranges)

Other sports

Do you participate in any other hazardous pursuits?

Private Medical Insurance Details

Do you currently have Private Medical Insurance?
Would you like us to quote you for this?

Client B

Are you a BMC Member?(1)
Are you a MCofS Member?(1)
Are you a Club Membership?(1)
How long have you been climbing?(1)
What best describes your climbing? (Select your highest level of participation)(1)
What grade do you climb to?(1)
Where do you climb?(1)
Max Altitude that you climb/mountaineer at(1)
Where do you climb outside the UK? (Please give geographical locations and ranges)(1)
Do you participate in any other hazardous pursuits?(1)
Do you currently have Private Medical Insurance?(1)
Would you like us to quote you for this?(1)
Where did you hear about us?*
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