Life Assurance for people with medical conditions

If you have a medical condition it can prove difficult to obtain Life Assurance. Orbis have a panel of insurers that are able to assess all cases individually.
Please complete the form below or contact us for more information.

First Life
Name
Date of Birth
Height
Weight
Are you a smoker? *    
Occupation  
Contact Tel.
   
Type of cover required
Sum Assured  
Plan term  
Name of medical condition
Date diagnosed
Medication
Any other medical conditions
 
Second Life
Name
Date of Birth
Height
Weight
Are you a smoker? *    
Occupation  
Email address
   
   
   
   
   
Name of medical condition
Date diagnosed
Medication
Any other medical conditions

 

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