Referral Form

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By clicking on submit I / We give consent for you to call me / us on the number provided to discuss my / our financial requirements.

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Referral/Enquiry Form

Adviser Name

Adviser Firm

FCA Number

Adviser Network (If Relevant)

Contact Number

Email Address

Referral Number (If Relevant)

Date of Birth

Gender

Occupation (If Known)

Details of disclosures (e.g. health conditions or other risks)

Please provide details of cover required (e.g. type, cover amount, term)

Please provide details of any insurers you've already tried and if they've all declined cover

Do you want us to contact the client directly to discuss or to come back to you first?

Please contact the customer Please contact me first

Please provide us with their details below. **

Customer name

Customer contact number

Customer email address

If there is anything else you think we would need to know please provide details below

** By providing the customer’s details, you confirm that have the customer’s consent to provide this information and have explained that Cura will be in touch to discuss this enquiry. If in doubt, please do not provide any contact details.

Additionally, the client will need to speak English or have an English speaking representative with them for us to help them.

Contact our IFA Specialists

Want to discuss a case? Please feel free to contact us:

– Free Phone: 0800 567 7450

– Telephone: 01723 518140

– Email: ifa@curainsurance.co.uk

It’s ideal if you can tell us the type of cover you think your client needs, and any circumstances that you think could affect a protection insurance application.

Prefer to submit an enquiry to us electronically? Please use our online referral form.

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Alan and his team were great! Alan helped get me cover where my own company could not (I work in financial services too!) Would highly recommend and will come back in the future.