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Endowment Questionnaire

Policy Details
Name
Address
Telephone Number
Email address
Who is your policy with?
Policy number
Sum assured	£
Term of policy	years
Type of policy (please tick box)	Unit-linked With-profits Don't know
When did you receive the advice to take the policy out and who from?
Premium payable
Life/lives assured
Date(s) of Birth	dd/mm/yy
Is the policy still being used as a repayment vehicle for your mortgage?	Yes No (please tick box)
If NO, please note here when and why you changed the arrangement.

About you
Please state your salary and outgoings at the time the policy was sold.
Gross annual salary	Self £ Partner £
Outgoing per month, excluding mortgage costs/rent (eg bills, food, clothes, leisure etc)	£
What was your occupation when the policy was taken out?	Self Partner
Did you have any dependents when the policy was sold?	Yes No (please tick box)
If YES, please give details.
What was your attitude to risk at the time the policy was sold?
What did the adviser discuss with you about what would happen if the policy did not make the returns as forecast? Did you tell the adviser about any concerns you might have had about making sure that the mortgage was paid off?
If you have not taken out your mortgage on an endowment basis, please give details of what you would have done instead (e.g. would you have chosen a capital repayment mortgage, stayed with your existing mortgage and not moved, rented instead of buying, lived with parents, etc?)
Were you advised to cancel or surrender any existing policy in order to take out the endowment policy? If YES, please give details.
Did you have any other investments or savings at the time you started the endowment policy? If so, please list them here. Include any bank/building society deposits, as well as stocks & shares PEPs / unit trusts / insurance policies / etc (please specify fund invested in if known).
Apart from your endowment policy/policies described above, did you have any life cover provided for you elsewhere (e.g. under another term insurance, whole-of-life or endowment policy, or attached to a personal pension plan or through your employer)? If YES, please give details.	Self Partner
Please give details of any pension arrangements you have (including length or membership in any occupational pension scheme(s) or details of personal plans).	Self Partner
At what age do you expect to retire?	Self Partner
What income do you expect to have in retirement (including pensions, continuing employment, investment income, etc)?	Self £ Partner £
At what rate do you presently pay tax (e.g. lower, basic, higher)?	Self £ Partner £

Windfall benefits
Have you received a windfall benefit from demutualisation of the firm that provided your endowment policy?	Yes No (please tick box)
If YES, what type of benefit was it?
Cash Amount £
Shares Number
Enhanced policy benefits Details
If you received shares, did you:	Keep them and still own them now Sell them (please tick box)
If you sold any shares that you received, please give details.	Date sold		Cash amount received £
	Date sold		Cash amount received £
Have you still got all of the windfall benefit received?	Yes No (please tick box)
If NO, how much of the windfall benefit has been spent and what was it spent on?
About your mortgage
What was the amount of your mortgage at the outset?	£
What is the name of your mortgage lender?
What is your mortgage account number?
Were you a first time buyer or an existing householder at the time of taking out your endowment? If not a first time buyer, please give details of your previous mortgage, saying whether it was on an endowment or repayment basis.
Have you paid anything other that the standard variable rate of interest on your mortgage or received special deals (e.g. fixed rate, discount, cashback etc)? If so please give details.
Were you told that the endowment mortgage would be cheaper than a repayment mortgage?	Yes No
	Please give details if applicable
Were you required to have life assurance by your lender as a condition of the loan?	Yes No Don't know (please tick box)
What was the date of the first payment you made to your lender? If not known please state the day of the month when you normally pay interest to your lender.

Is the amount of your monthly payment to your lender changes only once per year or does it alter more frequently, e.g. every time interest rates change? (Please attach a copy of your latest mortgage statement)
Have you moved lender or altered your mortgage in any way since taking out this endowment policy (e.g. by adding additional amounts to your original mortgage or by paying off lump sums)? If so please give details.	If so please give details.

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