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Title

First Name

Last Name

Date of Birth

Email Address

Telephone

Address 1

Address 2 (optional)

Town

County (optional)

Postcode

Have you used any tobacco, e-cigarettes, vaping or nicotine replacement products within the last 12 months?

What does this mean?

Tobacco use includes smoking cigarettes or a pipe, or chewing tobacco. Nicotine replacement products includes patches, chewing gum, lozenges, inhalers and sprays. E‑cigarettes includes all vaping products.

Yes, regularly (More than once a month)

Yes, occasionally (Once a month or less)

No, none at all

The information provided may be used by Insurers and Cavendish Online. If you do not proceed to application we still need to record that you used our system. We may contact you to assist with getting your protection in place. Further information relating to how we handle personal data and your GDPR rights is available here.

*The amount of cashback may vary between insurers. For full details please click here.

You are minutes away from Guaranteed acceptance and the best value cover...

Reasons to use Cavendish Online...

If you have any queries then please call 01392 539774 and speak to one of our friendly advisers.