Protection Enquiry Form

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

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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 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.

Main Office

Pure Offices Ltd
Brooks Drive
Cheadle Royal Business Park
Cheadle
Cheshire
SK8 3TD
Telephone. 03000 30 99 01
Email. nicholas.lightcamarguechambers.com

Quilter Complaints Department

If you have a complaint about your adviser, or any financial advice you have received from your adviser, please contact us:
Quilter Complaints Department
Riverside House
The Waterfront
Newcastle upon Tyne
NE15 8NY
Telephone. Tel: 0191 241 0700
Email. QFPcomplaintsquilter.com

Financial Ombudsman Service (FOS)

If you cannot settle your complaint with us, you may be entitled to refer it to the FOS (www.financial-ombudsman.org.uk). You can find more information by visiting the Intrinsic Financial Services website: https://www.quilterfinancialplanning.co.uk/
Website: www.financial-ombudsman.org.uk
complaint.info@financial-ombudsman.org.uk