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First name
Surname
Date of birth
Are you a smoker?

A non smoker is classified as a person who has not smoked cigarettes, cigars or pipe tobacco, used Nicotine replacement products like E-cigarettes, vaping, nicotine gum, patch, inhalers, hookah pipe, tablets, lozenges or sprays in the last 12 months

Add a second person (Joint Life basis)

First name (second person)
Surname (second person)
Date of birth (second person)
Are you a smoker? (second person)

A non smoker is classified as a person who has not smoked cigarettes, cigars or pipe tobacco, used Nicotine replacement products like E-cigarettes, vaping, nicotine gum, patch, inhalers, hookah pipe, tablets, lozenges or sprays in the last 12 months

Daytime contact number
Email address (optional)
Mortgage amount

The balance due on your mortgage

Mortgage term

The length of time remaining over which you are repaying your mortgage

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