Whole of Life Plan

Before you apply...

We take your privacy seriously and we will use the information you supply when applying online and information we obtain from other sources to verify your identity and to administer this policy. View our privacy policy for more information.

To carry on with the application you will need:

Your national insurance number
You won't need any bank account information at this stage - this will be requested when we post out your application for signing

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Read information

Your application should only take 10 minutes

Please read the following documents

Before we proceed though, you'll just need to confirm you have read and understood the following documents (don't worry about printing them out as we'll send them to you when you apply).

If you need to return to a previous page during your application, please use the arrows to the right of the screen and not the back arrow in your browser (top left).

Whole Of Life Product Information Pack
Download all

I confirm that I have read and understood the information provided above.

You must confirm that you have read and understood the information provided above.

Policy contributions

The policyholder must be aged between 16 and 70 (on their next birthday) to apply for this policy.

Policyholder details

Title *

Please let us know the policyholder's title

Full name *

Please let us know the policyholder's full name

Date of birth *

Please enter your date of birth

Second policyholder details

Title * (False)

Please let us know the second policyholder's title

Full name

Please let us know the second policyholder's full name

See what your sum assured could be

Your preferred monthly premium

I'd like the maximum cover available

Please choose an amount between £5 and £50

Please note: You can also enter the premium amount in the box instead of using the slider. In order to provide you with an accurate quotation, it is important that you provide us with correct details. Failure to provide the correct information may result in your application and quotation becoming invalid. This quote is based on the policyholder being in general good health at the outset, the sum assured (final amount) may be reduced or the policy declined based on the findings in the medical questionnaire.

Sum assured

The sum assured for the amount you have selected is too high. Please select a lower monthly premium to proceed.

Please read the Key information document and Important information documents before applying for a Whole of Life Plan.

Is this product right for me?

Financial services regulation requires us to assess whether this product you are considering, on a non-advised basis, is appropriate for you and meets your financial demands and needs.

Demands and Needs

Is it your wish to create a lump sum which would be payable on your death?

Yes No

Please complete this question

Are you simply looking for whole of life insurance rather than trying to make an investment gain?

Yes No

Please complete this question

Are you willing to accept that if you stop paying the premiums in the first ten years the policy will lapse and have no value?

Yes No

Please complete this question

Appropriateness

I have knowledge and familiarity with savings and/or investment products

Yes No

Please complete this question

I understand how this product works and the charges associated

Yes No

Please complete this question

I am comfortable and understand the level of risk associated

Yes No

Please complete this question

Please state your highest level of education

Please complete this question

I understand that I have not received any advice from Sheffield Mutual and I have made the decision to open this plan myself, based upon the product literature and Key Information Document for this product

Yes No

Please complete this question

Policyholder information

Are you the policyholder? *What's this?

Yes No

Please let us know if you are the policyholder

The policyholder is the person who the plan is for

Please enter your details (the proposer)

Title *

Please let us know your title

Full name *

Please let us know your full name

Date of birth *

Please let us know your date of birth

Email *

Please let us know your email

Telephone *

Please let us know your phone number

Postcode *

Or enter address manually

Address line 1 *

Please let us know your address

Address line 2

Address line 3

City/Town *

Please let us know your city

County

Please let us know your county

Postcode *

Please enter a valid postcode

Are you an existing member? *

Yes
No

Please let us know if you are an existing member

Where did you hear about Sheffield Mutual? *

Please let us know where you heard about Sheffield Mutual

Please specify *

Please let us know where you heard about Sheffield Mutual

What is your relationship to the policyholder? *

Please let us know your relationship to the policyholder

Marketing preferences

Sheffield Mutual will never sell your personal data to any third parties.

We would, however, like to keep you up to date with Society news, offers, competitions and other products and services that we offer. We use MailChimp for our marketing/service emails.

I agree to Sheffield Mutual contacting me via

Email Telephone Post Text

You can update your contact preferences easily at any time by phone, email, in writing or online.

Policyholder details

Name

Date of birth

01/01/0001

Email *

Please let us know your email

Telephone *

Please let us know your phone

Postcode *

Same as above

Or enter address manually

Address line 1 *

Please let us know your address

Address line 2

Address line 3

City/Town *

Please let us know your city

County

Please let us know your county

Post code *

Please enter a valid postcode

National insurance number What's this?

Please let us know your national insurance number

If the policyholder is 16 or older then you must insert their National Insurance number. This can be found on a wage slip, P45, P60 or DWP documentation.

Are you an existing member? *

Yes
No

Please let us know if you are an existing member

Where did you hear about Sheffield Mutual? *

Please let us know where you heard about Sheffield Mutual

Please specify *

Please let us know where you heard about Sheffield Mutual

Occupation *

Please let us know your occupation

Marketing preferences

Sheffield Mutual will never sell your personal data to any third parties.

We would, however, like to keep you up to date with Society news, offers, competitions and other products and services that we offer. We use MailChimp for our marketing/service emails.

I agree to Sheffield Mutual contacting me via

Email Telephone Post Text

You can update your contact preferences easily at any time by phone, email, in writing or online.

Health Questionnaire

Health and Lifestyle

Please state your height without shoes

Switch to metric

Please let us know your height without shoes

Switch to imperial

Please let us know your height without shoes

Please state your weight in indoor clothes. If you are currently pregnant, please state your pre-pregnancy weight.

Switch to metric

Please let us know your weight

Switch to imperial

Please let us know your weight

Have you smoked any cigarettes in the last 12 months?

Yes No

Please let us know if you have smoked any cigarettes in the last 12 months

How many cigarettes do you smoke per day?

Please let us know how many cigarettes you smoke per day

If you have given up smoking cigarettes within the last 12 months, please state your previous average daily consumption prior to giving up (we may ask you to undergo a simple test to confirm your answers to these questions).

Have you used any other tobacco products or any nicotine replacement products in the last 12 months?

Yes No

Please let us know if you have used any other tobacco products in the last 12 months

Other tobacco products include cigars, pipe smoking, vaping (e-cigarettes) and chewing tobacco (We may ask you to undergo a simple test to confirm your answer to these questions).

Do you consume alcoholic drinks?

Yes No

Please choose an option

Average units of alcohol per week

Please let us know details

A unit of alcohol is the equivalent to each of the following: a half pint of normal strength beer, lager or cider ~ one standard glass of wine ~ a single measure of spirit

Have you ever sought medical advice to reduce the level of your drinking?

Yes No

Please choose an option

Please give details

Please let us know details

Within the last five years, have you taken drugs other than for the treatment of a medical condition?

Yes No

Please choose an option

Please give details

Please let us know details

Other Life Applications

Has any application you've made for life, health or critical illness cover been declined, postponed or accepted with increased premiums, exclusions or restrictions?

Yes No

Please choose an option

Please give details

Please let us know details

Health and Medical Details

Have you consulted your doctor during the last 12 months for anything other than minor ailments or those listed?

Yes No

Please choose an option

Please give details

Please let us know details

Have you ever experienced angina, heart attack or any other disorder of the heart?

Yes No

Please choose an option

Please give details

Please let us know details

This question does include heart valve disorders, rheumatic fever, cardiomyopathy and heart abnormalities or defects present at birth.

Have you ever experienced stroke, Transient Ischaemic Attack (TIA), brain haemorrhage or any permanent brain injury through accident?

Yes No

Please choose an option

Please give details

Please let us know details

Have you ever experienced any form of cancer, leukaemia, Hodgkins disease, lymphoma, brain or spinal tumour?

Yes No

Please choose an option

Please give details

Please let us know details

Have you ever experienced multiple sclerosis, optic neuritis, Parkinson's disease, paralysis, cerebral palsy, dementia or Alzheimer's disease?

Yes No

Please choose an option

Please give details

Please let us know details

Have you ever experienced blurred or double vision, loss of feeling, numbness, pins and needles, tingling of the limbs or face or any disease or disorder of the central nervous system (brain, spinal cord and nerves), which has not already been mentioned in earlier questions?

Yes No

Please choose an option

Please give details

Please let us know details

Have you ever experienced diabetes?

Yes No

Please choose an option

Please give details

Please let us know details

Have you ever experienced any disease or disorder of the arteries including disease in the legs or of the aorta?

Yes No

Please choose an option

Please give details

Please let us know details

Within the last five years have you experienced: Anxiety state, stress, depression, chronic fatigue, any other mental or nervous illness?

Yes No

Please choose an option

Please give details

Please let us know details

Within the last five years have you experienced: Any problem, disease or disorder affecting your digestive system, stomach, bowel, liver, pancreas or gall bladder?

Yes No

Please choose an option

Please give details

Please let us know details

Within the last two years, have you had treatment for raised blood pressure or been advised to take treatment, or to have your blood pressure monitored?

Yes No

Please choose an option

Please give details

Please let us know details

Within the last five years, other than in respect of the conditions that you have already declared have you either: Received any medical attention at a hospital as an inpatient or outpatient, or, had or been advised to have any investigations, scans or blood tests including HIV?

Yes No

Please choose an option

Please give details

Please let us know details

Other than in respect of the conditions that you have already declared, are you currently: Experiencing any symptoms or complaints for which you have not consulted a doctor?

Yes No

Please choose an option

Please give details

Please let us know details

Other than in respect of the conditions that you have already declared, are you currently: Receiving any form of treatment or medication?

Yes No

Please choose an option

Please give details

Please let us know details

Other than in respect of the conditions that you have already declared, are you currently: Awaiting any medical or surgical consultation or follow up?

Yes No

Please choose an option

Please give details

Please let us know details

Other than in respect of the conditions that you have already declared, are you currently: Awaiting any test or investigation?

Yes No

Please choose an option

Please give details

Please let us know details

Doctors Details

Doctors full name

Please let us know your doctor's full name

Medical centre

Please let us know the name of your medical centre

Telephone number

Please let us know your doctor's phone number

Address line 1

Please let us know your doctor's address

Address line 2

Address line 3

City/Town

Please let us know your doctor's city

County

Please let us know your doctor's county

Postcode

Please let us know your doctor's postcode

Do you wish to see the Doctor’s medical report before it is sent to the Society?

Yes No

Please choose an option

In connection with this application I hereby consent to the Society seeking medical information from any Doctor, who at any time has attended me or has been responsible for my medical care, and I authorise the giving of such information and agree that a copy of this consent will have the validity of the original.

Please consent to the Society seeking your medical information

Read information

Policy contributions

Is this product right for me?

Policyholder details

Health questionnaire

Summary

Back to step 0

Whole of Life Plan

Read information

Please read the following documents

Policy contributions

Policyholder details

Second policyholder details

See what your sum assured could be

Sum assured

Is this product right for me?

Demands and Needs

Appropriateness

Policyholder information

Please enter your details (the proposer)

Marketing preferences

Policyholder details

Marketing preferences

Health Questionnaire

Health and Lifestyle

Other Life Applications

Health and Medical Details

Doctors Details

About us

Help and support

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Social responsibility

Corporate & governance

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Whole of Life Plan

Before you apply...

Read information

Please read the following documents

Policy contributions

Policyholder details

Second policyholder details

See what your sum assured could be

Sum assured

Is this product right for me?

Demands and Needs

Appropriateness

Policyholder information

Please enter your details (the proposer)

Marketing preferences

Policyholder details

Marketing preferences

Health Questionnaire

Health and Lifestyle

Other Life Applications

Health and Medical Details

Doctors Details

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