HOME ABOUT US OUR SERVICES LOCATION CONTACT US LINKS BUSINESS INSURANCE Commercial Insurance (Shops)        Commercial Insurance (Offices)        Liability Insurance        Property Owners Insurance        MORTGAGES Residential Property Mortgages        Commercial Mortgages        Investment Property Mortgages        Mortgage Questionnaire        FINANCIAL SERVICES        Pensions        Investments        Life Assurance / Serious Illness Cover / Income Protection        Life Assurance Quote        Mortgage Protection        HOME INSURANCE Request a Quote        House & Contents Insurance        Rented Properties Insurance        Holiday Homes (Ireland & Abroad)        HEALTH INSURANCE Vivas Health Insurance        MOTOR INSURANCE Commercial Vehicle Insurance        Motor Fleet Insurance                 Life Assurance           If you would like to receive further details of our Life Assurance products, contact us at the numbers below:          Rory O'Hanrahan: (087) 2536459          Rory@connollygaw.com Connolly Gaw (01) 2169952 Aidan Kerin: (086) 2546531          Aidan@connollygaw.com          Alternatively, complete this form to enable us to obtain a life quotation. As there are different types of Life Assurance Products i.e. mortgage protection, term assurance, whole life, serious illness etc., we will contact you by phone to discuss in greater detail your insurance requirements. (*required)        Title* Select...MrMrsMs        Surname*        First Name*        Phone*        Email Address        Smoker* Yes No        Age at next birthday* Select...181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071727374757677787980        Sum Assured* Select...€50 000€60 000€70 000€80 000€90 000€100 000€110 000€120 000€130 000€140 000€150 000€160 000€170 000€180 000€190 000€200 000€210 000€220 000€230 000€240 000€250 000€300 000€350 000€400 000€450 000€500 000€550 000€600 000€650 000€700 000€750 000€800 000€850 000€900 000€950 000€1000 000        Term* Select...1year2years345678910121314151617181920212223242526272829303132333435363738394041424344454647484950               Second Life Second life if any Yes No        Age at next birthday Select...181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071727374757677787980        Gender Male Female        Smoker Yes No        This form is for quotation purposes only and is not confirmation of a quote or insurance cover. Insurance cover will only commence on receipt of a completed proposal form, payment and written confirmation from Connolly Gaw Insurances.

Connolly Gaw Insurances Ltd is authorised by the Financial Regulator as an Authorised Adviser.        Connolly Gaw Insurances Limited - Unit F7, Nutgrove Office Park, Nutgrove Avenue, Rathfarnham, Dublin 14, Ireland          Phone: +353 (01) 216 9952        Fax: +353 (01) 298 9368        Email: info@connollygaw.com        Powered by: go2web