Income Protection. Your income is your most important asset... Are you protecting it?

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Income Protection

Your income is your most

important asset...


Friends First

Friends First, originally founded in 1834,

has a long standing presence in the Irish

market and has built up a reputation as a

leading financial services group in this

market. It provides a comprehensive

range of pensions, investments,

protection and finance products and

services to more than 250,000 clients.

The Group has enjoyed exceptional

growth in recent years. It has total assets

exceeding €

€5.5 billion and employs over

450 people, with offices in Dublin, Cork

and Galway.

In an international context, Friends First is

a subsidiary of Eureko B.V. Eureko is a

leading European financial services group,

with a total asset base of €

€83 billion and

over 20,000 employees in 10 countries.



Why Protect Your Income?


How Can I Protect My Income?


Why Choose Friends First Income



Our Product Benefits


What Can I Expect To Pay?


Claiming On Your Plan


Regulatory Information and


why protect your income?

Are you protecting your income, the one thing that pays for everything?

Have you ever thought about what would happen if you were unable to

work and your income ceased?

Take a few minutes to think about your financial commitments...

and how much you actually spend every month…

If you had no income, due to unforeseen illness or injury, how would

you pay for this lifestyle?

Have a think about how much you actually spend each month:

Current Salary


Mortgage / Rent


Home Insurance











•Mobile Phone


Car Loan


Car Insurance


Health Insurance


Monthly Regular Savings


Pension Contributions






Total Outgoings


We don’t usually think of our current income and our future earnings as

an asset. However, this is what pays for everything else – a mortgage,

bills, children’s education, insurances and so on. In general, we tend to

be overly optimistic about how we would manage if we were unable to

work due to illness or injury. Many people also tend to overestimate

company sick pay arrangements and the support provided by the state.

What arrangements does your employer have if you are on

long term sick leave?

How long would your savings last if you were to draw on them

every month to cover the cost of day to day living?

How would you continue to pay for your outgoings without an


Can you answer

the following?


Social welfare disability allowance

is just

€186 p.w. or €9,662 p.a.*

There is no social welfare disability

allowance if you are


* All quotations from Friends First/Lansdowne Market Research, April 2006.

how can i protect my income?

Many of us have thought about our retirement provision, and planning for

our future after we finish our working life. But what plans do we have in

place if our working life had to end sooner than expected?


Income Protection is a form of disability or sickness insurance that can help

prevent financial worries should you no longer be able to earn an income.

It is a very simple type of plan, that is becoming increasingly popular in order

to protect lifestyles in todays world. You simply pay a monthly premium, based

on factors such as your occupation, health, etc., that will ensure you receive

a regular income if you are unfortunate enough to be out of work. There are

no restrictions on the type of injury, illness or disability that are covered.

Best of all the important choices are up to you. You get to choose what style

of plan is best suited to your individual circumstances and can then add to

this as time goes on and your own lifestyle dictates.

CHOOSE the amount of your

salary you wish to cover

CHOOSE when you would like

the plan to start paying out

CHOOSE the premium type you would like

CHOOSE when you would like the plan to end




CSO in 2004 showed that 10.9% of the

population were classified with a


* All quotations from Friends First/Lansdowne Market Research, April 2006.

but why choose friends first income protection?

Friends First are renowned as the experts in Income Protection in Ireland and offer

the most comprehensive product in the marketplace. The Friends First Income

Protection product will provide you with a replacement income if you are unable to

carry out your usual work due to any illness, any injury, any disability or any accident.

You are entitled to claim for tax relief on premiums paid on an income protection

plan at your marginal rate (to a maximum of 10% of total salary).

The Friends First product is extensive and offers a number of

unique benefits not available on other products in the Irish

market. The range of key features and benefits

available are summarised on the following

pages. You can choose from these to

make your plan as tailored and

suitable to your own needs

as necessary.


Any questions call:

Friends First Direct

on 1890 201 430

choose your benefits with a friends

first income protection plan

• Maximum Benefit

The maximum benefit allowed on an Income Protection plan is calculated as

75% of the first €82,000 of your earnings plus 33% of the balance, less

social welfare benefits. This is subject to a maximum of €164,000

p.a./€3,155 p.w (excluding BIK’s). It is up to you how much of your

income you decide to protect and will depend on what other arrangements

you may have in place e.g. savings or employer sick pay that can be used

to supplement you when necessary.

• Waiting (Deferred) Time

The Income Protection plan will provide you with an alternate source of income

which is paid after a selected waiting time of either 3, 6 or 12 months


26 or 52 weeks).

This waiting time is the length of time between when the

illness is first diagnosed and when you start receiving an income benefit.

Again, depending on your own circumstances you may decide that it is only

after a certain time that you will need additional support. Perhaps your

employer offers a sick pay scheme that will pay if you are off work for 6

months - then the 26 week or 6 month waiting period might be appropriate.

• Age at which plan will end

You can choose the age you would like this plan to end: age 55, 60, or 65.

The age you choose for the plan to end could mirror your planned

retirement age.

Remember if you

are self employed,

you do not qualify

for Social Welfare



Only 10% of the Irish workforce

have any form of salary


* All quotations from Friends First/Lansdowne Market Research, April 2006.



• Premium Types

Guaranteed Premiums

The guaranteed premium option will ensure that your premium does not

change during the term of the plan, if your chosen benefits remain the

same. This is a key benefit of the Friends First Income Protection Plan and

we are the only company to offer this option. This provides the security of

knowing in advance how much your premiums will be over the term of

the plan.


Reviewable Premiums

The reviewable premium option will guarantee your premiums stay

constant for the first 5 years of the plan. We will review the premium

every 5 years thereafter. In the review, we will take into account claims

experience over the preceding years and changes in economic conditions.

We will also take into account any medical breakthroughs and the discovery

of any new diseases. If it is necessary to change the premium, we will

offer you the choice of an increase in premium or a reduction in benefits.

• Level of benefit

You can choose at the beginning of your plan if you would like your premium

and benefit to remain the same throughout the term, or to be automatically

increased to keep in line with inflation, pay increases and so forth.


You can index your income benefit by 3% each year. This feature applies

before, during and after any claim you make, and ensures that as your

salary increases each year, so too will your replacement income. Your

premiums will also increase by 3% each year.



You can alternatively select escalation. This feature means that your

income benefit itself will increase by either 3% or 5% p.a., whichever you

select, from the anniversary of the expiry of the waiting period. Your

premiums themselves remain level under this option.



The premium and level of benefit are guaranteed not to change for the

duration of the policy.

• Tax Relief

You are entitled to claim for tax relief on premiums paid on an income

protection plan at your marginal rate

(to a maximum of 10% of total salary).

In the event of a claim, you will receive your income benefit net of income

tax under PAYE.

95% of our

customers choose



75% of our

customers choose



to friends first



to friends first

automatic benefits with a friends first

income protection plan

• Guaranteed Increase Option

Our unique Guaranteed Increase Option allows you to increase your

income benefit by 20% of your original amount without having to provide

new evidence of health. This offer will be made to you every 3 years.

• Occupation Change

A Friends First Income Protection plan will continue to cover you if you

change jobs, regardless of what your new job entails. If you are made

redundant, your plan will continue while you are looking for another job.

• Hospital Cash Benefit

Under the Friends First Income Protection plan, you can receive an income if

you are in hospital for over 7 days. No waiting period applies to this payment.

• Automatic Premium Protection

You will not have to pay your premiums while you are receiving an income

benefit and your plan continues so that if you do return to work and at some

stage in the future need to claim again your plan has continued unchanged.

• Rehabilitation Benefits

Many people at the time of their illness do not want to stop working and

are eager to get back into the workforce after their recovery – either to their

old job or in a new career – either full or part-time. We offer a number of

different benefits to assist you if you are getting ready to go back to work.

Relapse Benefit

We will immediately restart paying your benefit if you have a relapse

within 6 months of returning to work – there will be no waiting period in

this case.

Partial Benefit

If you return to work either in your old job or a new career, either

part-time or full-part-time and your new earnings are less than what you previously

earned you may be eligible to receive partial benefit.

• Overseas Benefit

If you claim income benefit while you are outside the European Union, we

will pay your income for 13 weeks in a 52 week period or 39 weeks in total.

If you return to Ireland or the European Union within this time, we will

continue to pay your income benefit.


to friends first

Need Help? Contact Friends First Direct on

1890 201 430


Over 90% of our

customers choose

Individual Income


• Product Choice

In addition to the detailed product benefits there are two different plans

which you can choose from.

Individual Income Protection

Individual Income Protection is our standard plan. It is designed for those

that are self-employed or for an employee who takes out the policy

independently of their employer. It is a very comprehensive plan with a

number of benefits unique to Friends First.


Mortgage Income Protection

Our mortgage plan has been designed specifically to cover the regular

mortgage and loan repayments you would face if you were out of work due

to an illness or disability. It is linked to the term of your mortgage. Mortgage

Income Protection is a streamlined version of our Income Protection plan,

and as such offers many of the product benefits outlined above.


With a Friends First Income Protection plan YOU choose

the benefits suited to


Amount of Salary you wish to cover

Waiting Time

Premium Type

Age at which plan will end




* All quotations from Friends First/Lansdowne Market Research, April 2006.

No automatic requirement for

sick pay from either your

employer or Union*


what can i expect to pay?

Friends First is the leader in the Income Protection market in Ireland. We offer

not only the most comprehensive and flexible product in the market place

but we are also extremely competitively priced. The cost of your plan will

depend on the options you decide to take, your occupation and health. It is

very easy to fit a plan into your budget that you can review and enhance as

time goes on.


Tom O’Brien is an accountant who currently earns €52,000 p.a. He is a 34

year old, non-smoker and as he is self-employed, he doesn’t qualify for the

State Disability payment.

He decides to take out cover on 50% of his current salary i.e. €26,000 p.a.

This is on a 3 month (or 13 week) waiting time and is until his retirement at

age 65. He also chooses guaranteed and level premiums.

Policy will provide:

€26,000 p.a.


€2,166.67 p.m.


€500 p.w.

Gross premium:

€66.54 p.m.

Net premium:

€39.26 p.m.

(41% tax rate)

And remember even if you have some kind of a medical condition that you

feel might exclude you from cover, that’s not necessarily the case. We may

offer you cover with an exclusion clause for that condition, but covering all

other eventualities or simply offer you cover with an increased premium.

calculate the value of your future earnings

Normal Retirement Age



Current Age


(Multiplied by)

Current Annual Salary


Total Value of Salary

Now do you realise the value of

Income Protection?



Examples of

Current Claimants

40 year old Accountant, out of work since May 1999 with depression. Benefit paid to date €520,000.

45 year old Carpenter, out of work from Feb 2005 to Feb 2006 with a fractured leg and ankle. Benefit paid to date


40 year old Accountant, out of work since 2001 with depression. Attended a career change programme and now is back working part-time in an IT consultancy firm, with benefit continuing on a partial basis. 29 year old Occupational Therapist out of work since 2004 with a back and neck injury. Returned to work part-time in Jan 2006 and 50% of benefit continued to be paid until returned full-time in April 2006. Total benefit paid


50 year old insurance salesman was unable to work due to stress. His claim paid for 3 years and then he undertook a Career Change Programme with Friends First. 6 months later he returned to work in a management position with a charity organisation.

claiming on your plan

At Friends First, we are particularly proud of our unrivalled claims record.

We feel that this is one of the key advantages of our Income Protection product.

In 2005:

€11.2 m was paid by us in claims

• Almost 90% of claims submitted were accepted

• Average length of a claim was 5 years

• Average payment was €17,500 p.a.

Our Health Claims Team don’t just act as administrators to issue your

payment. They are here to help you through every step of your claim both

before it starts and once it has commenced for as long as you need us. For a

person who does need to claim this can be a very difficult time with not only

financial concerns but concerns about what the future might hold. We pride

ourselves on being able to offer a range of additional services and resources

to all of our claimants

should they wish to avail of them.

These include the

following services:

Claims Visitors - Independent qualified nurses or professionals who will visit

you to assist you in the completion of paperwork and the claims procedure.

Later on, if you wish they can undertake review visits to discuss

rehabilitation options or re-training programmes.

Rehabilitation - We work closely with the Irish Centre for Occupational

Rehabilitation to assist you in continuing with your normal everyday

activities and ultimately to allow you to return to employment.

Return to Work - This is a joint initiative with BUPA Ireland Occupational Health

to assist you in getting back to work and focuses on your particular job and

workplace to see if any adjustments can or should be made to assist you.

Career Change - This programme has been developed by Friends First in

conjunction with Talent Fusion. It is designed to help if you are unable to

return to your normal occupation but wish to continue working and will help

with seeking a new career.

We also are very happy to speak to you directly

on our lo-call number

1890 882 019

This helpline is available for all queries on new

or existing claims and requests for information

on our range of services and resources.


Regulatory Information and Application Form


Your income is your

most important asset...

Are you protecting it ?


Policyholder details:

Name : Specimen

Age next birthday : 35 Sex : Male Smoker Status: Non-smoker Ceasing age: 65

Information about the policy

Make sure the policy meets your needs!

Purpose of this policy:

The Income Protection Plan – Individual is a regular premium income protection plan. The primary purpose of income protection is to pay you an income if you are unable to work due to illness or injury and have suffered a loss of earnings as a consequence.

Nature of the commitment:

This policy requires an initial premium of €66.54 to be paid monthly. Unless you are fully satisfied as to the nature of this commitment, bearing in mind your needs, resources and circumstances, then you should not enter into the commitment. If you are ceasing premiums on an existing policy your Financial Advisor will advise you of any consequences (see the declaration on the application form).

What happens if you want to cash in the

policy early or stop paying premiums?

Cashing in this policy:

This policy does not acquire a surrender value.

Premium Cessation:

The policy will terminate with no value if you stop paying premiums. Please note however that once we start paying benefit to you we will not ask you to pay any more premiums until your claim finishes.

What are the projected benefits under

this policy?


You will pay €66.54 monthly by direct debit until 2038. Your premium and income benefit are guaranteed not to change throughtout the term of this policy. The premium quoted covers the cost of the risk benefits, all charges, expenses and intermediary remuneration. The premium is broken down as follows:

Initial premium €66.54 p.m. Less Tax relief @ 41% €27.28 p.m. Net Monthly cost €39.26 p.m.

The above figures are inclusive of a €2.54 per month policy fee.

Assumptions about the benefits and

costs detailed:

• The breakdown of the premium as illustrated is based on the average cost of the risk benefits spread over the full term. • For underwriting purposes, your job is a

class 1 risk.

What Intermediary/sales

remuneration is payable?

The projected cost of providing benefits, services and the total payments to your intermediary are illustrated below (see table 2).

Are returns guaranteed and can the

premium be reviewed?

Guaranteed returns:

The benefits chosen are guaranteed for the term of this policy provided the required premiums are paid when due. Friends First may have to reduce the level of benefit paid out on claim, if the level of benefit chosen is greater than the maximum level allowed under our Limit on Benefits, as outlined in our conditions.

Premium Review:

Your premium is guaranteed not to be reviewed during the term of this policy.

Can this policy be cancelled or

amended by Friends First?

Friends First can cancel or amend this policy, if at any time, any of the following happens: a) the Revenue Commissioners remove their

approval of this policy

b) it becomes impossible or impracticable to continue providing any of the benefits due to changes in the law or other circumstances beyond our control;

c) the tax treatment of Friends First or this policy is changed;

d) you are or become ineligible to effect or maintain this policy;

e) the Government introduces additional levies or duties on this policy;

If we need to cancel or amend this policy we will write to you and explain the reasons for the actions and inform you of your options.


If any information supplied in this quote is inaccurate Friends First reserves the right to adjust the premium or benefit to reflect the true quotation basis. Your completed application form will form the basis or the contract between us. If you inaccurately disclose or do not disclose a material fact on the application form, this may invalidate any future claims on this policy.

Information on taxation issues

Relief on premium:

• You can claim tax relief at your highest rate on Income Protection premiums. The maximum level of premium on which tax relief is available each year is 10% of your earned income.

Tax on proceeds and/or benefits:

• Income payments from this policy are subject to income tax under PAYE.

Additional Information in relation to

your policy :


Income Benefit

Amount/Type of cover:

€500 per week.

Your benefits explained:

• The income protection policy will provide you with an income while you are unable to work due to illness or injury and have suffered loss of earnings as a consequence. This income will start 13 weeks after the event happens. The policy will continue paying an income to you until:

i) You are able to return to your normal occupation as outlined in the policy conditions, OR

ii) You are no longer suffering from a loss of earnings,


iii)You reach your selected ceasing age, OR

iv) You die, whichever is earlier • The policy has a hospitalisation benefit

included. This unique feature will pay a daily hospitalisation benefit if you have to stay in hospital for more than seven days in the period before your income payments start.

Disclosure Illustration for Friends First Income Protection Plan


table 1

Illustrative table of projected benefits and charges.

Year Total amount Projected Projected Projected Protected policy of premiums investment expenses cost of value paid into the growth to and charges protection

policy to date date to date benefits to date

1 €798.00 €0.00 €568.00 €230.00 €0.00 2 €1,597.00 €0.00 €1,117.00 €480.00 €0.00 3 €2,395.00 €0.00 €1,641.00 €754.00 €0.00 4 €3,194.00 €0.00 €2,141.00 €1,053.00 €0.00 5 €3,992.00 €0.00 €2,606.00 €1,386.00 €0.00 10 €7,985.00 €0.00 €4,394.00 €3,591.00 €0.00 15 €11,977.00 €0.00 €4,903.00 €7,074.00 €0.00 20 €15,970.00 €0.00 €4,903.00 €11,067.00 €0.00 Maturity €24,354.00 €0.00 €4,903.00 €19,451.00 €0.00 table 2

Illustrative table of intermediary/sales remuneration. Year Premium Projected Total

payable in intermediary/sales that year remuneration

in that year 1 €798.00 €961.00 2 €798.00 €24.00 3 €798.00 €24.00 4 €798.00 €24.00 5 €798.00 €24.00 10 €798.00 €24.00 15 €798.00 €24.00 20 €798.00 €24.00 31 €399.00 €12.00


• This policy has an increasable insurance option included as standard. With this option it is possible to take out additional income protection policies with Friends First without providing any additional evidence of health. This option is available only if this policy has been issued on standard terms. This option is available every three years beginning on the third anniversary of the policy start date and ending on the fifteenth anniversary of the policy start date. The option is not available within 5 years of the policy end date. The following conditions apply to any new policy taken out under this option.

a) The income benefit must not be more than 20% of the original income benefit under this policy;

b) The benefit structure of the increasable insurance option i.e. Premium/Benefit Type, Deferred Period .must be the same as under this policy;

c) The aggregated income benefit from all related policies must not be greater than the maximum benefit allowable under this contract;

d) There will be no further increasable insurance option on any new policy/ policies;


e) Other terms and conditions will be those available as standard at the time the policy was taken out.

If this option is not exercised on two consecutive occasions when it is offered, it will not be offered again and it is not possible to exercise an option: During a Period of Disability lasting a week or more; Within six months of such a Period of Disability; While any benefit is being paid under this policy. A waiver of premium benefit is also automatically included. This benefit will pay your premiums on your behalf as soon as you start receiving income payments.

Term of this policy

The term of this policy is 31 years.

Law applicable:

The policy is written under section 125 of the Taxes Consolidation Act 1997 (as amended).


This contract will be governed at all times by the laws of the Republic of Ireland. All contract terms, communication and documentation pertaining to this policy shall be in English.

Cancellation Rights and Complaints


You will receive your policy documentation shortly after it is issued. We ask you to read this carefully. If you feel the policy is not suitable for your needs you may cancel it by sending written instructions to us within 30 days from the policy issue date. All premiums paid will be refunded in full on cancellation. Once the Cancellation Period has expired the Policy Conditions will describe the rights accruing under the policy. Any enquiries or complaints should be directed to your local Friends First Office in the first instance. You should then refer to our Customer Relations Manager if necessary. We endeavour to ensure that all matters in relation to your policy are dealt with in a satisfactory manner. Friends First complies with the Irish Insurance Federation complaints procedure and a copy of this procedure is available from your local Friends First office or the IIF.

In the event that you are dissatisfied you have the right to refer your complaint to the Financial Services Ombudsman's Bureau. The Bureau may be contacted at: Financial Services Ombudsman's Bureau, 3rd Floor, Lincoln House, Lincoln Place, Dublin 2. Lo-call: 1890 88 20 90, Fax: 01 662 0890, Email:, Website: The law of the Republic of Ireland will apply in any disputes.

Information about the Insurer:

Friends First Life Assurance Company Limited Head Office:

Friends First House, Cherrywood Business Park, Loughlinstown, Dublin 18, Republic of Ireland Tel: (01) 661 0600 Fax: (01) 661 6651 E¬mail: Web:

Registered as a Limited Company in the Republic of Ireland No: 165970

Friends First Life Assurance Company Limited is regulated by the Financial Regulator.

Generic Information

Information is provided to ensure that this policy meets your needs. The tables give generic information for particular ages and terms. Specific information for personal details is available upon request and will be provided when we issue your policy document. Please read all this information carefully and contact us if you need any assistance.

Note on this illustration

This is an illustration for a policy underwritten by Friends First Life Assurance Co. Ltd. and must be read in conjunction with the Income Protection Plan – Individual leaflet. It assumes that the life assured is accepted on normal terms and conditions. This illustration is based on Income Protection Plan – Individual terms and conditions as at 29/01/07, which may change from time to time.

Terms of Business

Friends First Life Assurance Company Limited


We provide savings, investments, protection and pension products.

We are a limited liability company registered in Ireland No. 165970.


We charge sales fees on all business conducted directly with us. The fee will vary depending on the product, and will be set out in the Personal Illustration provided. We reserve the right to amend our sales fees from time to time. The details of all other charges and their impact on the type of policy are set out in the policy documentation and depend on factors such as fund choice and investment premium.

Conflicts of Interest

We will make all reasonable efforts to avoid conflicts of interest and when they cannot be avoided, we shall ensure that you are treated fairly at all times. Should an unavoidable conflict of interest arise, we will draw this to your attention at the earliest opportunity.

Complaints Procedure

We comply with the Irish Insurance Federations Code of Practice, which requires the use of “plain English” in our communications with you. All complaints will be dealt with by a member of staff with the knowledge and experience to deal with the matter promptly and fairly.

We endeavour to reply to all complaints within 5 working days. If this reply is an acknowledgement rather than a full reply we will advise you of the name and contact details of the person dealing with your complaint and the estimated time scale for a full reply. We will keep you informed if the original time scale cannot be met. If you are not happy with the response you receive from us and wish to escalate the complaint you may refer your complaint to the Financial Services Ombudsman’s Bureau of Ireland. The Bureau may be contacted at: Financial Services Ombudsman's Bureau, 3rd Floor, Lincoln House, Lincoln Place, Dublin 2. Or to the Financial Regulator at PO Box No. 9138, College Green, Dublin 2.


Friends First treat all information provided to it as confidential and will not disclose such information except as permitted by you or as required by law. The information provided will be held on both computer and manual files and will only be used for the purposes registered under the Data Protection Acts 1988 and 2003. From time to time we may send you information about new products and other services available which may be of interest to you. If you do not wish to receive such mailings simply write to us at the address below and we will ensure that you only receive communication specifically related to your policies. All communication relating to any service we provide will be in English. All services provided are governed by the Laws of the Republic of Ireland.

Cooling Off Period

All of the products which we provide contain a 30 day right of cancellation. To exercise this right you should write to us, within this time period at our address below. The conditions pertaining to the right can be found in the ‘Cancellation Rights and Complaints Procedure’ section of the document titled ‘Your personal disclosure illustration” which is enclosed.


Individual Income Protection Plan Application Form

Mortgage Income Protection Plan Application Form


Contract type: Policy/Contract number: Client number: Intermediary: Agent/Agency No.:




Mr. Mrs. Ms. Place of birth:

Surname: Date of birth: Age next birthday:

First name(s): Marital Status:

Country of residence: Home Tel. No:

Mobile. No:

E-mail address:




Weekly benefit: Age at which benefit will end: 55 60 65 Waiting period: 13 26 52 weeks

(Max. 75% of Gross Annual Salary less Social Welfare disability) (3 ) (6) (12 months)

Premium type: Guaranteed: OR Reviewable:

(Please select one only)

Type of cover required? Level Benefit: OR Indexation benefit OR Benefit in payment escalating at either 3% or 5%

(Please select one only) (Benefit & Premium increase by 3% p.a.) (Premiums remain level with this option)


Monthly benefit: Term: Waiting period: 3 6 12 months

(To a max. age of 65) (13 weeks) (26 weeks) (52 weeks)

Type of cover required? Level Benefit OR Indexation benefit (Benefit & Premium increase by 3% p.a.)

Is this a new mortgage for your principal primary residence? Yes: No: Was the mortgage taken out within the last 2 years? Yes: No: €

Premium: Frequency of Premium: Payable monthly quarterly half yearly annually

Policy start date: Premium collection date:


Please tick the plan you are applying for: Individual Income Protection Mortgage Income Protection

What is your occupation? Type of business you work in:

Gross Annual Salary: Income tax rate Are you self-employed or a share-holding director? Yes: No: If 'Yes', for how long? Years: Months: Number of employees working for you (including sub-contractors)if applicable?

If you were unable to drive could you still carry out your current occupation? Yes: No:



if you answer yes to any question please give details in the

space provided at the end of the form

Are any of the following an important part of your job or working environment?(Please tick if yes and give details at back of form.)

Travel abroad/offshore Working in extreme temperatures Working at heights Manual/Physical Activity Working at depths Using Machinery Tools Other (Please specify)

Daily Duties:

Does your employer provide an income if you are out of work due to illness or disability: Yes No If yes, for how long?

Please tick if you have any of the following: Income Protection Disability Benefit Please state amount of cover p.m.


Yes No 1 a) Have you consulted a doctor or required medical

supervision for any of the following: cold and flu, food poisoning, operations (tonsils, ingrown toenails, appendix,

vasectomy), acne, childhood illnesses (mumps, measles, chicken pox), sinusitis or verruca?

b) For reasons other than those listed in Question 1 a): Have you, within the last five years, consulted anyone, for example: doctors, hospitals, clinics, counsellors or osteopaths about your physical or mental health. Are you taking any medicine or drugs, (whether or not prescribed

by a medical practitioner) or receiving any treatment?

c) Have either of your parents, or any brother or sisters, died or suffered from heart disease, a stroke, diabetes, high blood pressure, kidney disease, cancer, multiple sclerosis, nervous disorder, or any hereditary disease such as Huntington's disease before age 65. If yes - please give details i.e. which family member & age at diagnosis.

(If cancer, please advise the location of same).

d) Have you ever tested positive for HIV/AIDs, Hepatitis B or C or have you been tested/treated for any other sexually transmitted disease, or are you awaiting the results of such tests?

2 Have you ever suffered from;

a) Depression, insomnia, exhaustion, an alcohol problem, anxiety state, nervous breakdown?

b) Stress, chronic fatigue or other nervous or mental disorder? c) Epilepsy, fits, blackouts, giddiness or migraine?

d) Bronchitis, asthma, pneumonia, pleurisy, tuberculosis or any other affection of your lungs?

e) Backache or disc problem, any muscular, rheumatic, bony or other joint problem?

f ) Fainting, palpitation, undue shortness of breath, chest pain, rheumatic fever, raised blood pressure or other affection of your heart or circulatory system?

g) Persistent or recurrent indigestion, ulcer (gastric or duodenal), gallstones or any disease of your stomach, bowels or liver? h) Any problems with your kidneys or bladder?

i) Diabetes or any abnormality of your urine e.g., the presence of sugar, albumin or blood?

j) Varicose veins, piles or hernia?

k) Any problems with your eyes 0r vision (not wholly corrected

by spectacles)?

l) Any problems with your ears, hearing or balance?

m) Any surgical operations?

n) Psoriasis, eczema or dermatitis?

Yes No

o) Lumps, bumps or moles or any other skin problem? p) Multiple Sclerosis, tremor, loss of power or tingling in any

of your limbs?

Yes No 3 a) Please indicate if you currently have a GP

In the event of Friends First needing to refer you to a doctor for an independent medical examination, please advise a convenient location and we will do our best to facilitate you.

b) Your height (without shoes) ft ins

Your weight (in indoor clothes) st lbs Yes No

c) Have you smoked any cigarettes, cigars, pipes or tobacco in the last 12 months?

If ‘yes’, how many per day?

d) Do you drink alcohol?

If ‘yes’, how many units per week?

(1 unit = 1 glass of wine / lager / 1 measure of spirit)

If ‘no’ when did you last drink?

e) Have you ever been treated for alcohol abuse, or been advised by a doctor to cease or reduce your alcohol consumption or taken drugs other than for medical reasons?

4 a) Do you, or do you intend to engage in hazardous sports,

pastimes or occupations of any kind e.g. Mountaineering, motor sports, diving, equestrian or aviation (other then as a fare paying passenger), specialist employment such as building? (Please specify below)

b) Do you intend to travel, work or reside outside the Republic of Ireland (excluding holidays)? (Please indicate below

where you will be travelling to.)

5 Have you ever been declined, postponed or accepted on

special terms by Friends First or any other insurer for life, critical illness or permanent health insurance? Please give details of the company and sum assured


If you answer ‘yes’ to any of the questions below, please give

details in space provided at end of form

Name of doctor: Address:

per day per week Additional Information





If your proposal for insurance is declined or if you are offered insurance on special terms, then this fact will be noted on a central registry, administered by the Irish Insurance Federation and may be shared with other insurance companies as a protection against non-disclosure of material facts. 1 I submit this application, along with any subsequent information provided in relation to this application verbally by either me or the agent acting in the sale

of this policy, which is subsequently confirmed to me in writing, to Friends First Life Assurance Company with a view to entering into a contract for the benefit set out herein. I understand that unless instructions to the contrary have been given by myself the contract will commence on the acceptance of this application, and additional information provided verbally (if applicable) by Friends First Life Assurance Company on its normal terms and conditions (which I am aware are available on request)

2 I have read over the replies to all the questions in this and declare that to the best of my knowledge and belief, all information given is true and includes all material facts. I consent to Friends First verbally seeking and receiving additional information from me or my agent where this information has not been provided on the application or where further information is required in order to process the application and such information will be deemed to be incorporated into this application. I consent to Friends First seeking medical information from any doctor who has at any time attended me concerning anything which affects my physical or mental health, or seeking such information from any insurance office to which an application has been made for assurance on my life and I authorise the giving us such information. I agree that this authority shall remain in force after my death as well as prior thereto. I further understand that in the event of my being medically examined the answers given by me to the medical examiner acting on behalf of Friends First Life Assurance Company shall be deemed to be incorporated into this application.

3 I undertake to inform Friends First of any change in my country of residence during the life of the policy.

4 I understand that Friends First Life Assurance Company Limited must be notified of any changes in my health and/or circumstances prior to the assumption of risk.

5 I hereby give my consent to the use and recording of my personal details (contained herein) by both electronic and print means to Friends First Holdings Limited.


Signature of life to be insured:

DECLARATION TO BE COMPLETED BY CLIENT: I confirm that I have received in writing the information specified in the above declaration. Please state your existing policy number if you are cancelling or replacing a Friends First policy:

The presale disclosure information you received is in a generic form and specific illustrative tables will be issued to you with your policy documentation. Date:




I declare that the information provided by me in this Application Form accurately reflects my financial circumstances and that any recommendation given by Friends First will be based on this information.




I declare that I do not require any financial advice in relation to Income Protection and I understand the nature of the commitment that I am entering into with Friends First and believe it to be suitable to my requirements.


DECLARATION OF INSURER OR INTERMEDIARY: I hereby declare that in accordance with Regulation 6 (1) of the Life Assurance (Provision of Information) Regulations, 2001, I have provided the proposer named on this form with the information specified in Schedule 1 and 3 of those Regulations and that I have advised the client as to the financial consequences of replacing an existing policy by cancellation or reduction, and of possible financial loss as a result of such replacement.





If you propose to take out this policy in complete or partial replacement of an existing policy, please take special care to satisfy yourself that this policy meets your need. In particular, please make sure that you are aware of the financial consequences of replacing your existing policy. If you are in doubt about this, please contact your insurer or insurance intermediary.

Signature on behalf of Insurer or Insurance Intermediary:

Signature of life to be insured:



exemption in relation to genetic tests

You are not required to disclose any genetic test results you may have had and we will not have regard to any genetic tests which may come into our

possession. You are, however, required to provide us with full details (other than genetic test) in answer to the preceding health questions including full details about your family history as required in the Health Details section.

data protection acts, 1988 and 2003:Friends First Life Assurance Co. Ltd., will treat all information given to it as confidential and will not disclose such information except as permitted by you or as required by law, the information provided will be held on computer and will only be used for the purposes registered under the Data Protection Act, 1988. This information may also be used to send you details about other services available from Friends First that might interest you.

If you wish to avail of this service please tick this box.

Signature of life to be insured:



How to work out the Maximum Benefit for Income Protection.

The formulae below apply to the self-employed and non self-employed both weekly and monthly.

Maximum Allowed Monthly Benefit Amount

The lesser of €13,666 OR (Applicable Annual Salary - Social Welfare

Benefit amount)/12

Maximum Allowed Weekly Benefit Amount

The lesser of €3,155 OR (Applicable Annual Salary - Social Welfare Benefit


Applicable Salary = 75% of first €82,000 of Annual Salary plus 33% of remaining Annual salary.

If life assured is an employee the current social welfare benefit amount is currently €9,662 p.a. (January 2007)

If the life assured is self-employed the social welfare benefit amount is €0 Friends First Life Assurance Company Limited,

Friends First House, Cherrywood Business Park, Loughlinstown,

Dublin 18.

Friends First Life Assurance Company Limited is regulated by the Financial Regulator. Friends First is part of the Eureko Group.

Please use this space to tell us any other relevant information or special instructions about your policy.



9 9 0 4 5 7

1.The Manager:

(Full address of your bank/building society in capitals)


Please complete parts 1-4 to instruct your bank/building society to make payments directly from your account. Then return the form to Friends First, Friends First House, Cherrywood Business Park, Loughlinstown, Dublin 18. Originator's identification number: Originator's reference: (maximum 18 characters)

2.Name of account holder:

Surname: Initials:

Banks/Building Societies may decline to accept instructions to pay direct debits from some types of accounts.

3.Sort code: Account number:

4.Your instruction to the bank/building society:

• I instruct you to pay Direct Debits from my account at the request of Friends First Life Assurance Company Ltd

• I confirm that the amounts to be debited are variable and may be debited on various dates

• I shall duly notify the Bank in writing if I wish to cancel this instruction. I shall also notify Friends First of such cancellation.

The Direct Debit Guarantee

• This is a guarantee provided by your own Bank as a member of the Direct Debit Scheme, in which Banks and Originators of Direct Debits participate

• I f you authorise payment by Direct Debit, then

• Your Direct Debit originator will notify you in advance of the amounts to be debited to your account

• Your Bank will accept and pay such debits, provided that your account has sufficient available funds

• If it is established that an unauthorised Direct Debit was charged to your account, you are guaranteed a prompt refund by your Bank of the amount so charged

• You can cancel the Direct Debit Instruction in good time by writing to your Bank


Your signature(s):


Product Details

Minimum Premiums:





Age Limit:

Minimum Entry Age: 19 NBD

Maximum Entry Age: 55 NBD

(if the ceasing age chosen is 65 see term limits below)

Term Limits:

Minimum: 5 years

(or 10 years for ceasing age 65)


to age 65

Policy Fee:

2.54 p.m. /

7.62 p.q. /

15.24 p.h.y. /

25.40 p.a.

Please note: Terms and conditions may apply.

This brochure gives an overview of the Friends

First Income Protection product (Individual

and Mortgage). For further information please

contact Friends First Direct on 1890 201 430.


Friends First Life Assurance Company Limited, Friends First House,

Cherrywood Business Park, Loughlinstown,

Dublin 18.

Friends First Life Assurance Company Limited is regulated by the Financial Regulator. The Friends First Group is part of the Eureko Group.

BR053 Jan 2007

Next Steps

Call Friends First Direct on

1890 201 430





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