Re-Mortgage Risk Report

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Lives Assured

Single Life Joint Life

Personal Details

First Life

Client Name

SecondLife

Client Name

Current Age

2060

Current Age

2060

Gender

Male Female

Gender

Male Female

Smoker

Yes No

Smoker

Yes No

Employment Details

First Life

Employment Status

Second Life

Employment Status

Annual Income

Occupation

Existing Cover

Does your client have Mortgage Protection?

Yes No

Does your client have Critical Illness Protection?

Yes No

First Life

Second Life

Does your client have Income Protection?

Yes No

(monthly amount)

Mortgage Details

Mortgage Type

Repayment Interest Only

Monthly Mortgage Cost

Postcode

New Mortgage Amount

Term (Years)