Step 1 of 616%Adult Standard Savings Plan ApplicationWe are delighted that you have decided to apply for a Healthy Investment Standard Savings Plan. Please complete the simple steps. If you have any questions about the Adult Standard Savings Plan or application process, or if you would like us to send you an information pack by post, please call 0161 762 5790 or email us email@example.comBefore you can proceed, please confirm that you have read and understood the following documents.Key Information DocumentDownloadTerms & ConditionsDownloadConfirmation* I confirm that I have read and understood the Key Information Document and Terms & Conditions. If you have any queries in regard to these documents please contact us before proceeding. Policyholder DetailsTitle*Name*Surname*Email* Phone*Date of birth* DD MM YYYYMinimum age = 16Maximum age = 49National Insurance Number (for all policyholders over 16)*Address 1*Address 2Address 3City*CountyPostcode*Click yes if the premium payer for your plan has different details to the Policyholder details you specified above.*YesNoPremium Payer DetailsTitle*Name*Surname*Email* Phone*Date of birth* DD MM YYYYAddress 1*Address 2Address 3City*CountyPostcode* The InvestmentUnder current tax rules each individual can only invest up to £25 per month or £270 per year in friendly society Tax Exempt Savings Plans – If you wish to invest over this amount please complete this form.Select whether you would like to save monthly or annually.*MonthlyAnnuallyAmount monthly*Please enter a number from 10 to 300.Please enter a value between £10 and £300 or £275 if you're already using your £25 per month tax exempt allowance.Amount annually*Please enter a number from 120 to 3600.Please enter a value between £120 and £3600 or £3325 if you're already using your £275 per annum tax exempt allowance.Maturity Date*Please select which method you would like to use to tell us your savings plan's maturity date.No. of yearsEnter a dateNo. of years or Date of maturity (between 15 and 25 years)*Please select1516171819202122232425Your savings plan must mature BEFORE your 65th birthday.Date of maturity (between 15 and 25 years)* DD MM YYYYYour savings plan must mature BEFORE your 65th birthday. Health InformationAs this savings plan includes life insurance we need to ask you some medical questions in order to determine the level of life cover we are able to provide. We may request further information or you may be contacted by a specialist medical underwriter for further information. All information you provide will be treated in the strictest confidence. Failing to disclose information may mean that we are not able to accept your application or the policy may not be able to pay out on death. The questions relate to the person who is the policyholder:Has any proposal for life, health, sickness, accident or critical illness insurance ever been declined, postponed, or accepted on special terms?*YesNoHas a doctor been consulted in the past 5 years about any illness, operation, medical investigation or counselling?*YesNoIs prescribed medication currently being taken?*YesNoHas the policyholder ever tested positive for HIV/AIDS or hepatitis B or C or are results of such tests awaited?*YesNoDoes the policyholder participate in any hazardous activity at work or leisure?*YesNoWeight*Height*If you have answered yes to any of the above questions then please provide full details.*Is there any other information which you think any company providing life insurance would reasonably be expected to know? Please read through these documents before proceeding with your application.The General Data Protection Regulation (GDPR) requires us to provide you with a Privacy Notice to make you aware that the information you provide will be held by Healthy Investment and will be used for setting up and administering your savings plan.The Healthy Investment & HMRC declaration requires your confirmation in order to enable your savings plan application to be processed. If you have any questions regarding these documents please call us on 0161 762 5790.Data Protection InformationViewHealthy Investment & HMRC DeclarationViewWe will never share your information with other companies or organisations for marketing purposes.* I confirm that I have noted the data protection information, and my agreement to the HMRC and Healthy Investment declaration. I agree to receiving newsletters and other emails from Healthy Investment which, under data protection rules would be classed as marketing emails. I can unsubscribe at any time. SummaryThis is a summary of your Adult Standard Savings Plan Application (with life cover). Please check your details carefully before you proceed. Once you are happy, please click the Submit button below. This iframe contains the logic required to handle Ajax powered Gravity Forms.