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Life Assurance Ireland Barker - Independent financial advisors - Dublin Ireland - Call 1850 373 222
 
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Suite 20/21, The Mall,
Beacon Court,
Sandyford,
Dublin 18,
Ireland.

Tel: 1850 373 222
E-mail: info@barker.ie

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Quotation for Life Assurance

Please complete the details below and we will contact you with a quotation or alternatively phone us on 1850 373 222

APPLICANT CONTACT DETAILS
First Name
Surname
E-mail
Telephone No.
LIFE COVER DETAILS
What is the purpose of the cover?

What type of cover do you require
(Tick appropriate box(es)

Income Protection
Serious Illness
Term Assurance
Whole of Life
Is this a single or joint life cover?
Single cover
Joint cover (see below)
How many years?
APPLICANT DETAILS
MAIN APPLICANT
JOINT APPLICANT (If applicable)
Date of Birth
Day
Month
Year
Sex
Male
Female
Smoker
Yes
No
Date of Birth
Day
Month
Year
Sex
Male
Female
Smoker
Yes
No

 

Contact us for more information

Call us now on 1850 373 222 and we will go through all the options and help you choose the policy that best suits your needs.

 
Contact Eilis Keaney, your Barker representative. Click here to e-mail Eilis
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Mortgage brokers & independent financial advisers Ireland Click here to e-mail Barker at info@barker.ie
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