Life Insurance Questionnaire

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Please note: Based on your answers, we will calculate the cost of your insurance manually to ensure accuracy and the best possible coverage for your needs.

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Personal Information

First Name

Last Name

Phone number

Your phone number is required so we can quickly contact you if we need more information or to confirm important details about your insurance request. We respect your privacy and will never share your number without your consent

Personal Information

Nationality

At Pitsas Insurance, all clients are treated equally, regardless of their ethnicity or nationality. We ask this question to help us match you with the most suitable insurance advisor. We work with more than 10 qualified advisors from 5 different countries who speak a total of 8 languages. Our goal is to provide you with clear and accurate information in the language you understand best

Date of birth

We ask for your age to provide accurate quotes and meet regulatory requirements. Age can affect eligibility, pricing, and potential discounts. This allows us to offer you the most suitable options. Your information is kept secure and strictly confidential.

City

Occupation

Life Insurance Information

Coverage Amount (€)

Cover Duration (number of years)

Life Insurance Information

Purpose of Contract

You can choose more than one option

Mortgage

Cover

Savings

Life Insurance Information

Do you have any pre-existing medical conditions or currently take prescription drugs for any medical condition?

Yes

Please provide more information

Submit

Would you like to add extra coverage to your quote?

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No, thanks

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Life Insurance Questionnaire

Pending Changes