About you and your household

Your health

Your family's health

Your travels and hazardous pursuits

Request your Preliminary Insurance Assessment and Quote

Acknowlegement and privacy policy

I have read and agreed to the Merlin Terms of Use, Privacy Policy and the Financial Services Guide. I volunatarily consent and agree for Merlin to offer, invite me to apply or contact me (including via telephone where they have my valid consent) in relation to all products and services they provide, including life insurance advice.

What happens next?

1. You are emailed a copy of this form

   Once you submit this form, you will be emailed a copy of your Submission.

2. We assess your submission

   Once we've assessed your responses, you will be emailed a Preliminary Insurance Assessment and Quote. Expect to receive this on the following business day. It could take longer if you have/had multiple medical conditions, for example.

3. Invitation to take up our insurance advice offer

   We invite you to take up our insurance advice offer, so you and your loved ones can be financially protected.

   This starts with a free, no obligation online Teams meeting with one of our Insurance Advisers, at a day and time that's convenient to you.

   Our end-to-end insurance advisory services starts with understanding you and your requirements, so we can tailor an appropriate protection strategy. Once you decide to proceed with your chosen cover, we will assist with the application process. Once the policy is in place, we help you manage and review your protection strategy.