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Your Details

Full Name

House Name or Number and Street

Address 2

Town City

Postcode

Date of Birth (dd/mm/yy)

Spouse or Partner's Name (if appropriate)

Spouse or Partner's Date of Birth (dd/mm/yy)

Retirement Details

When do you want to take your pension(s) benefits

Who are your pensions with

Estimated Pension Fund (required)

Contact Details

Preferred Phone Numbers

Mobile number (if different)

Best Time to Call You

E-mail Address

Note: we only use your email address to contact you about this quote request; we do not provide this information to any third parties.

Health/ Lifestyle Questions For You (These can lead to higher annuity rates)

Do You Smoke?

If 'yes', how many per day?

Please provide details of any Medical Conditions

Health/Lifestyle Questions For Your Spouse/Partner

Does He/She Smoke?

If 'yes', how many per day?

Please provide details of any Medical Conditions

Any other comments you wish to add?

Data Protection

In accordance with the Data Protection Act 1998, the personal information you have provided will be treated in the strictest confidence.

The information you provide is confidential. By submitting this form you agree that Cade & Co llp t/a click4annuities may use or hold your personal information for the purpose of contacting you to discuss your quote request.  We will not use this information for marketing without your consent or other purposes and will not pass your details to third parties except where it is required to obtain a quote unless the information is required by law.