Protection Enquiry Form

The internet is not a secure medium and the privacy of your data cannot be guaranteed.

Thank you for your enquiry, someone will contact you shortly.

Title

Forename(s)

Surname

Telephone

Mobile

Email Address

Best Time to Call

Your Address

House Name / No.

Street

Town

County

Postcode

Cover Required

Life Cover Product

Term of Cover (years)

Family Income Benefit

Renewable

Amount of Cover

Cover Basis

Premium Type

Premium Frequency

Lives Assured

Cover Type

1st Life Assured

Date of Birth (DD/MM/YYYY)

Sex

Smoker

Previous Health Problems

2nd Life Assured

Date of Birth (DD/MM/YYYY)

Sex

Smoker

Previous Health Problems

Submit Your Information

How did you hear about us

Your Privacy

We take your privacy seriously. Personal data submitted to Camargue Chambers LLP with this form will be treated in accordance with the General Data Protection Regulation 2016 and the Data Protection Act 2018. By submitting this enquiry form you expressly consent to be being contacted in relation to your enquiry, without prior notice or arrangement, using the contact details provided on the form.

UK News

The Job Support Scheme will see the government top up the pay of people who can only work part-time in "viable jobs".
Students are told not to socialise outside of their accommodation this weekend in a bid to stem Covid.
Latest figures show 6,634 new coronavirus cases across the UK, taking the total to 416,363.
Users are being urged to install the app to protect themselves and others against the resurgent virus.
Alexandra Wilson says she was challenged by court staff who assumed she was there to face charges.