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Keyman Term Life cover provides a lump sum payment to you as the employer as a result of death to a key man in the company or death of a partner                                                  The lump sum payment can help you replace a key man, or can be used to buy out your partner's share of the business after death                                                   Policy covers death from any natural cause                                                        Cover for death extends worldwide                                                      Optional covers can also be included in the same policy: Trauma Recovery, Total & Permanent Disablement, Income Protection, & Business Expenses                                                          Simply complete the form below                                             We will also meet you face to face outside business hours to answer questions & help you fill out the paperwork

On-Line Keyman Term Life Insurance Quote


Thank you for considering our on-line keyman insurance quote service. Brokers National acts as multi agent for life risk products. We aim to find you the best keyman insurance deal possible.

Please fill in the following form - answering all questions, then either:

1. Click on "Email to Brokers National" at the bottom of this form.  OR                               

2. Highlight this form to "Print It" and then "Fax It" to our office on 03 9791 6633.


 Use the Mouse or the Tab key to move to the next field. We will respond with quotes as soon as they have been received from our insurers.

 

Keyman Term Life(& Optional TPD, Trauma, Income Protection)

Personal details:

Your Name:
Gender: Male    Female
Date of birth:  
Do you smoke? Yes    No
Occupation:

Duties  / Work You Do / Responsibilities:

Any recent Health problems?


In addition to keyman term life optional covers are also available:
Keyman Term Life protection: $ Sum insured
Optional Total & Permanent Disablement: $ Sum insured
Optional Trauma Recovery protection: $ Sum insured

If you are also seeking income protection:
Monthly gross salary before tax: $ per month
Monthly cover (maximum 75% of salary): $ per month
Waiting period requested (days): 14    30 (Recommended)   90    Excess
Cover period in years (Accident/Sickness): 2/2       5/5       60/60       65/65

If you are also seeking optional cover for fixed business expenses:
Monthly gross fixed business expenses: $ per month (eg. vehicle repayments)
Waiting period requested (days): 14    30 (Recommended)   90    Excess
Cover period in years (Accident/Sickness): 2/2       5/5       60/60       65/65

Any other comments, requests or relevant information you need to add:


Contacting you about your quote:

Please make sure you leave a contact phone number and the best time to call you.
Your Name:
Company name:
Your Phone Number & Area Code:
Best Time(s) To Call:
Please send my quote by (select at least one): email     phone     fax     mail
Your Email:
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Click On Email Quote To Send         Form To Us
 

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