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So that we can help you find appropriate insurance we will need to contact you to discuss your case in full. Rather than create a large form to cover all eventualities, we prefer to use this simple form to get a brief understanding of the case, so that the most appropriate advisor can contact you.
Items marked * are required input.

Your Name
		Title

		First Name

		Surname

Your Email Address *

Your Contact Phone Number


We need to understand as much as possible about the insurance you have been declined.


Which insurance company declined your application ?


What insurance were you applying for ?
(e.g. Life Insurance, Buildings and Contents, Medical Expenses etc)


What reason did they give for declining your application ?
Please give as much information as possible



Any other information you would like to give us.
In order to help you, we will need to get one of our specialists to call you. It will however help us if you could provide any other information you feel is relevant.


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This website is owned and operated by Platinum Financial Consulting
Authorised and Regulated by The Financial Services Authority

Written quotations available on request

Telephone : 0845 83 87 811 Fax : 0871 277 1422 Email : info@platinumifa.co.uk

FSA Registration Number : 227014

Declined Life Insurance Specialists