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Impaired Health Annuity Quote
Impaired Health Annuity Quote
We can quote for pension funds of £20,000 or more (£15,000 after tax free cash). Fill in One Form to search providers offering higher rates for illnesses including heart attacks, strokes or cancers.  
 
  Free Quotes No Obligation All Providers  
  * Indicates a 'Required field', which must be filled before submitting the form.  
 
My Details
  We help thousands of people each year with their annuity quotes. For the fastest service, please provide a daytime or home contact number and address so we can send you guaranteed quotes from the leading annuity provider. Your details are only used in relation to your pension annuity enquiry.  
     Timescale considered for changes:  
     How did you find our website:  
 
  * Name:
 
  * Address 1:  
     Address 2:  
  * Town/City:  
     County/Country (if overseas):  
  * Postcode:  
 
  * Email address:  
  * Phone number:  
 
  * Your date of birth:
 
  * Your retirement date:
 
  * Your gender:  
     Main occupation during working life:  
 
     Partner's Name (if joint):
 
     Partner's date of birth (if joint):
 
     Partner's gender (if joint):  
     Partner's occupation during working life (if joint):  
 
Pension Scheme Details
  If your pension fund is £15,000 or more after tax free cash we can produce a quote for you. Using the statement from your provider, enter the fund value of non-proteced rights and protected rights (if applicable) and the total value of your pension fund. If you want to take 25% tax free cash, deduct this from the total fund value. The 'Purchase Annuity' box is used for the annuity quote.  
  * Type of pension:  
 
     Non-protected rights:  
     Protected rights (if applicable):  
 
     Total fund value:  
     Tax free cash (25% maximum):  
  * Purchase Annuity:  
 
Features of your Annuity
  If you are comparing our quote to the annuity income shown on your provider statement, please ensure you are comparing "like for like" and that the features you add are exactly the same. The default is a level annuity, single life, paid monthly in advance with no guarantee. Please change this if required.  
     Annuity benefits:
    (Is this for a single or joint life annuity)
  
     Survivors pension:
    (If joint, spouse's income from 50% to 100%)
  
 
     Payment frequency:
    (Receive your income from monthly to annually)
  
     Payment type:
    (Pays at start or end of payment frequency)		  
     Escalation rate:
   (Select from none to 5% income increase)		  
     Guaranteed period:
    (Continues to pay if annuitant dies early)		  
 
Medical Questionnaire
  The following is the full Medical Questionnaire the provider underwriters use to produce a quote for you. You can complete this online or we can post this to you to complete. If you select by post, please make sure the required fields above are completed, then proceed to the bottom of the page to submit this form.  
     How would you like to complete this form?:
Post: Online:
 
 
Lifestyle Conditions
  Please enter height and weight for you and your partner (if joint). Enter details if you smoke and if you suffer from high blood pressure or high Cholesterol.  
  About You Your Partner
  Height (cms or ft & ins):
  Weight (kgs or st & lbs):
     
  Are you currently a smoker and have been for the past 10 years?
Yes:  
No:  
Yes:  
No:  
  Please advise the average number of:
  Manufactured cigarettes per day
  Cigars OR ounces/grams of pipe tobacco 
you smoke per day
  Ounces/grams of cigarette tobacco you
smoke per day
  If you suffer from high blood pressure please advise:
  BP readings POST medication
(systolic/diastolic) if known
  State the Name and quantity of prescribed medications taken per day
  If you suffer from high Cholesterol please advise:
  Cholesterol level POST medication
(mmol/l) if known
  State the Name and quantity of prescribed medications taken per day
 
Medical History
  For the most competitive quotes, please ensure you mention and fully detail medical condition(s) both past and present and answer all applicable questions for each condition about you and your partner (if joint) under the headings 1, 2, 3. For cancer, please state location, and if it is carcinoma in situ this must be specified. For diabetes, see the section following.  
  About You Your Partner
  Condition 1
  Name, date diagnosed and description
  Name and quantity of prescribed medications taken per day
  Condition 2
  Name, date diagnosed and description
  Name and quantity of prescribed medications taken per day
  Condition 3
  Name, date diagnosed and description
  Name and quantity of prescribed medications taken per day
 
  Your Conditions Partner's Conditions
    When did you last suffer symptoms or receive treatment for this condition?
  (tick 1 per condition)
  1 2 3  
  1 2 3  
  Not applicable
   
   
  Within 6 months
   
   
  6 months - 2 years ago
   
   
  2 - 5 years ago
   
   
  More than 5 years ago
   
   
    How long have you suffered from this condition or when first diagnosed?
  (tick 1 per condition)
  1 2 3  
  1 2 3  
  Not applicable
   
   
  0 - 1 years
   
   
  1 - 5 years
   
   
  5 - 10 years
   
   
  More than 10 years
   
   
    When were you last hospitalised for this condition?
  (tick 1 per condition)
  1 2 3  
  1 2 3  
  Not applicable
   
   
  Never
   
   
  0 - 1 years ago
   
   
  1 - 5 years ago
   
   
  More than 5 years ago
   
   
    What treatment have you received in the last 2 years for this condition?
  (tick 1 per condition)
  1 2 3  
  1 2 3  
  Not applicable
   
   
  Nothing
   
   
  1 - 2 different prescribed
medications daily
   
   
  3 + different prescribed
medications daily
   
   
  Special treatment: Surgery,
Radiotherapy, Renal
Dialysis, Chemotherapy
   
   
    Concerning your mobility, in respect of this condition, are you?
  (tick 1 per condition)
  1 2 3  
  1 2 3  
  Not applicable
   
   
  Fully independent
   
   
  Able to walk only with
assistance, e.g. stick
   
   
  Permanently and irreversibly
Wheelchair bound
   
   
  Permanently and irreversibly
need daily nursing care
   
   
  Permanently and irreversibly
bedridden
   
   
 
Diabetes Conditions (if applicable)
  If you also suffer from diabetes, please complete the following questions.  
  About You Your Partner
  What type of diabetes do you have?
      Not applicable
      Controlled by diet only
      Non insulin dependent diabetes
      Insulin dependent diabetes
  Do you have any related conditions due to your diabetes?
      Kidney disease
      Eye disease
      Heart disease
      Poor circulation
  If insulin dependent diabetes, frequency you take insulin per day?
      Not applicable
      One
      Two
      Three
      Four or more
     
  Date you were diagnosed with diabetes?
     Please give the name and quantity of all prescribed medication you
   and/or your partner are taking for the diabetes:
  Additional comments you would like to make regarding this form:  
Sending the form
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Suitability
Use this single form to approach all the providers in the market for people with a pension fund of £20,000 or more (£15,000 after tax free cash). Higher impaired rates are offered from providers if you suffer or have suffered in the past from illness such as heart attacks, strokes, cancer or other serious illnesses.		  
   What happens now?
Free Quote Service
By submitting this form you are not under any obligation or commitment to purchase an impaired annuity from us. The impaired annuity quote service is free of charges.		  
For the Medical Questionnare, if you select the post option we will send you this form to the address given for you to complete.  
Highest Rates
Once your enquiry is received we send this medical questionnaire to all the impaired annuity provider underwriters. We compare the most competitive rates offered sending you the guaranteed quote from the highest provider.		  
How we can help
If you need further information or wish to proceed with the annuity quote our annuity experts can process all paperwork on your behalf, deal with both life company's administration, giving a personalised service at no extra cost to you.		  
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