Whole Life Protection - Swiss Insurance Partners

Thank you for requesting a personal quotation via Internet.

This form is designed for your convenience and to handle your request most efficiently. Please tick the appropriate boxes and fill in the relevant fields according to your individual needs.

Please note that Swiss insurance policies can be tailor-made to suit the most individual needs. There are many extra features available such as premium waivers in case of disability or death, annuity reduction for joint annuitants, etc. Please contact us for individual advice and assistance to provide you with the best solution.

The Whole Life Protection policy will provide the beneficiaries with a lump sum when the insured person dies. This means lifetime cover and financial security for beneficiaries.

	Yes, I would like to receive a personal quotation for a Whole Life Protection policy on
		one life (insured sum is paid upon death)
		joint life (insured sum is paid upon first death)

Insured person 1st insured person
Date of birth*	/ /
Gender*
Country of residence*
Nationality*

2nd insured person
Date of birth*	/ /
Gender*
Country of residence*
Nationality*

Annuity specifications
Currency*
First premium payment and start of life protection (dd/mm/yyyy)*		/ /
Upon death of the insured person(s), the beneficiaries should receive the sum of*		minimum of USD 250'000 or equivalent
I would like to receive a quotation for a*

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Contact information
Please send my personal quotation to the following address:

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Country*
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Additional information

*required information

Important Note: All information is treated with highest confidentiality once received by us. However, data contained in this form may be viewed by third parties while in transit. For maximum information security print this form and send it by fax or mail.

Due to international differences in legislation and regulatory constraints, Swiss Insurance Partners make no warranty of any kind, express or implied, regarding the availability of any product or insurance scheme in any country.