Income Protection Application

* Name

* Contact Number

* Email

* Date of Birth

* Sex please select Male Female

* Smoker please select Yes No

* Salary scale please select €0-10,000 €11,000-20,000 €21,000-30,000 €31,000-40,000 €41,000-50,000 €51,000-60,000 €61,000-70,000 €71,000-80,000 €81,000-90,000 €91,000-100,000 €100,000+

* Tax Rate please select 20% 41%

* Retirement Age please select 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70

* Monthly Benefit Amount

* Occupation Please select most suitable Accountant Actor Actuary Acupuncturist Advertising Agent Air Conditioning Engineer Air Traffic Controller Aircraft Ground Technician Alarm Installer/Engineer Anaesthetist Antique Restorer Antiques Dealer Archaeologist Architectural technician Armed Forces Aromatherapist Artist Auctioneer (Livestock) Bailiff Baker Bank Officials Bar Person Barber Barrister Beautician Bedroom fitter Biochemist Biologist Blacksmith Blind Maker Boat Builder Boilerman Book Binder Book keeper Book Maker (Shop only) Bricklayer Broker (Insurance) Broker (Securities) Building Clerk Building General Business Consultant Butcher (No Slaughtering) Butcher (Slaughtering) Cabinet Maker Café Proprietor Car mechanic Car sales Caretaker Carpenter Carpet fitter Cashier Caterer Cattery worker Chauffeur Chef Chemist - chemical industries Chemist – shop assistant Chemist/pharmacist Childcare Chimney sweep Chiropodist Chiropractor Cinema staff Civil engineer Civil servant – Clerical Cleaning Interior Clergyman Clerk Coal merchant – office only Cobbler Commodity Broker/Trader Compositor Computer operator Confectioner Contract Cleaner Courier (Van) Court Bailiff Credit controller Cycle and repair shop Dental equipment engineer Dental Hygienist Dental Surgeon Dental Technician Diamond Cutter Diamond Polisher Diplomatic Service Distilling Distilling sales Doctor / GP Draper Draughtsman Dress Designer Dressmaker Driving Examiner Dry cleaner Economist Editor Film & Assistant Editor Newpaper/Magazine Electrical Engineer Electrician Electrician - automobiles Electro plater Engineer Engraver / Etcher Estate Agent Factory worker - Admin only Factory Worker Farm Manager Farm Worker Farrier Film Cameraman Film Director Film Editor Film Sound Fish & Chips shop Fish management Fishmonger Fitter – aircraft Fitter – bedroom Fitter – fireplace Florist French Polisher Fruiterer Funeral Director Funeral Director Employees Gamekeeper Gas fitter General Practitioner Geologist Glass Blower Glass Engraver Glazier Goldsmith Graphic Designer Green Grocer Greenkeeper Hairdresser Health Visitor Heating Engineer Horticulturist Hotel Manager Inseminator - Artificial Insurance Broker Insurance Inspector Interior Designer Interpreter Jeweller Joiner Journalist Kitchen designer Lab Technician Labourer Laundry Worker Lecturer Librarian Lift E'eer Lithographic Printer Locksmith Management Consultant Marine Biologist Marine Engineer Mason Midwife Milk Roundsman Milkman Milling Operatives Neurosurgeon Newsagent Newscaster Nurse - Psychiatric / Prison Nurse otherwise Occupational Therapist Optician Orthodonist Osteopath Packer Painter & decorator Panel beater Pathologist Personnel Officer Pest controller Petrol pump attendant Pharmacist Photographer – studio only Physiotherapist Piano Technician Plasterer Plumber Post Master/Mistress Post Office Postman Psychiatrist Publican Publisher Quantity Surveyor Radio/TV engineers Radiographer - Industrial Radiographer - Medical Radiologist - Medical Receptionist Restaurateur Saddler Sail Maker Sales Assistant Sales Rep Secretary Shoe Repairer Shop work Sign Writer Silk Screen printer Social Worker Software developer Solicitor Sound Technician Stockbroker Stonemason Surgeon Tailor Taxidermist Teacher Telephone Technician Telephonist Tiler (Bathroom) Tool maker Tour Operator Traffic warden Translator Travel Agent Turf Accountant TV Engineer Typographer Underwriter Upholsterer Valet Veterinary Surgeon Waiter/Waitress Watch maker Water Treatment Consultant Window dresser Wine & Spirits Merchant

* Employment please select Employed Self Employed

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