Enquiry Further Details – Simply Retirement

1Address

2Annuity Information

3Your Health

4Your Partner

5Finally

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Title

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First Name

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Last Name

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Email(Required)

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Phone

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Date of Birth

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Amount to provide annuity (£)

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The fund value is

Your Address Details

Search Address by Postal Code

Address

Street Address Address Line 2 Town Postcode

Health and Lifestyle

Please provide accurate information about your health. This information can get you up to 40% more from your pension.

Marital Status

Residential Status

Are you Retired?

Occupation when working

Next we need to ask about you height and weight, Would you like to provide the information in Imperial or Metric?

Height Feet :

Inches

Height (Cms) :

Weight: Stone

Pounds

Weight (Kgs) :

Waist Size (Inches) :

Waist Size (Cms) :

How many units of alcohol do you consume per week (If Applicable)?

Smoker

Are you a smoker or previously a smoker?

Are you currently a smoker?

Regular Smoker for last 10 Yrs

Date Started (MM/YYYY)

What do you smoke

Cigarettes

Cigars

Rolling Tobacco

Pipe Tobacco

How many cigarettes do you smoke daily?

How many cigars do you smoke daily?

How much rolling tobacco do you smoke weekly?

How much pipe tobacco do you smoke weekly?

Do you have High Blood Pressure

Date of Diagnosis

Last Reading from Doctor

Your Latest Readings

Systolic

Diastolic

Medication For High Blood Pressure

Name

Dose

Amount

Frequency

Per

Date Started

Do you have High Cholesterol?

Date of Diagnosis

Last Reading from Doctor

Last reading (mmol/L)

Medication for High Cholesterol

Name

Dose

Amount

Frequency

Per

Date Started

Medical Conditions

Tell us about any past / current medical conditions

Heart and Vascular Condition

Diabetes

Stroke

Respiratory / Lung Disease

Multiple Sclerosis

Neurological Disorder

Cancer

Please provide – Name of Condition, Date of Diagnosis, Symptoms, Treatment and Medication]

Spouse / Partner

Tell us about your partner and any past / current medical conditions they have:

Title

Firstname

Surname

Partners Date of Birth

Relationship to You?

Are they Retired?

Occupation when working?

Next we need to ask about your partners height and weight, Would you like to provide the information in Imperial or Metric?

Spouses/Partners Height (Feet)

Inches :

Spouses/Partners Height (Cms)

Spouses/Partners Weight (Stone)

Pounds

Spouses/Partners Weight (Kgs)

Spouses/Partners Waist Size (Ins)

Spouses/Partners Waist Size (Cms)

How many units of alcohol do they consume per week (If Applicable)?

Are they a smoker or previously a smoker?

Regular Smoker for last 10 Yrs

Date Started (MM/YYYY)

What do they smoke?

Cigarettes

Cigars

Rolling Tobacco

Pipe Tobacco

How many cigarettes do they smoke daily?

How many cigars do they smoke daily?

How much rolling tobacco do they smoke weekly?

How much pipe tobacco do they smoke weekly?

Do they have High Blood Pressure?

Date of Diagnosis

Last Reading from Doctor

Partners Latest Readings

Systolic

Diastolic

Your Partners Medication For High Blood Pressure

Name

Dose

Amount

Frequency

Per

Date Started

Do they have High Cholesterol?

Date of Diagnosis

Last Reading from Doctor

Last reading (mmol/L)

Your Partners Medication for High Cholesterol

Name

Dose

Amount

Frequency

Per

Date Started

Medical Conditions

Tell us about any past / current medical conditions:

Heart and Vascular Condition

Diabetes

Stroke

Respiratory / Lung Disease

Multiple Sclerosis

Neurological Disorder

Cancer

Please provide – Name of Condition, Date of Diagnosis, Symptoms, Treatment and Medication]

and finally…

Please tick which option suits your request

I need help with researching the annuity company only

I am just comparing rates.

I would like to explore all my options, including Flexi-Access Drawdown

Could you confirm the best contact number and time to reach you, should we have further questions?

Telephone

Best time to call?

Any information you submit to us is secure and adheres to our privacy policy. These services are only available to UK residents.

Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Further Details

Your Address Details

Current Pension

Annuity Options

Health and Lifestyle

Smoker

Medical Conditions

Spouse / Partner

Medical Conditions

and finally…

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