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"Dear visitor","A S U - basic detail","First names &nbsp;*","Last Name &nbsp;*","Address","Postcode &nbsp;*","Email Address *","Phone"," &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Applicant 1 &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Applicant 2",
"Dates of Birth &nbsp;*","items marked * are required"," Title &nbsp;*","Mobile","A S U &nbsp;- employment &amp; benefits<br><br><br><br> - employment &amp; benefits"," &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Applicant 1 &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Applicant 2",
"Occupation","Employment status - choose category","Length of service with current employer - months","Industry /Nature of Business","Employers name","Employers address including Postcode","Type of cover required","Excess period selected","Benefit period required","Product required (if known)","Gross Monthly Income &#163;","Monthly benefit required &#163;","A S U &nbsp;- benefit calculator","Mortgage","Rent/Council Tax","HP/Loans/Credit Cards","Gas/Electricity/Water","Insurances","Other","Total Monthly benefit",
"Please specify &quot;Other&quot; e.g. School Fees, Maintenance etc","Is the policy to protect a new mortgage or re-mortgage","Start date of mortgage existing or new","What date is cover to start","Do you have any similar insurances to the one you areapplying for","Total benefit amount you are insured for under all other accident, sickness and/or unemployment insurances &#163;","What is the name of your mortgage lender","A S U - underwriting questions","If you have answered NO to questions 1 or 2 or YES to any question 3 to 11 then please provide further information in the box opposite",
"Declaration of Insurance","Please read the following statements and signify your acceptance of the terms by clicking the &quot;accept&quot; option at the bottom","I am applying to you for insurance under your normal terms and conditions. I confirm that as fas as I know, all the statements made in connection with this proposal are true and complete whether or not in my handwriting and I have not concealed any important fact. I realise that failure to disclose relevant facts may void payment under the insurance so arranged.<br>I have received a copy of the policy information brochure and I will keep a record of all information I give under this proposal. <br>I agree to inform you in writing of any change in circumstance affecting the statements I have made in this proposal, which occur between the date of this application and the date the policy commences.<br>Data Protection Act 1998 &amp; Access to Medical Reports Act 1988<br>I consent to the seeking and processing of any information from third parties directly concerned with the underwriting and administration of the insurances applied for.<br>I understand that such information provided by me may be held on computer or otherwise and will be used for the purposes of administering the insurance cover, and will be made available to others for claims handling purposes (including fraud investigations).<br>Underwriters may seek medical information from any doctor who at any time has attended me concerning anything which affects my physical or mental health or seeking information from any insurance office to which an application has been made for personal insurance and I authorise the giving of such information in perpetuity. I understand that if access is not allowed to my medical records either during my lifetime or after my death that the underwriters (or their agents) cannot be held liable for any delay or non payment of any claim. ",
"A S U - Direct Debit","Bank","Postcode","Sort Code","Account name","Account number","Bank details","Please indicate most convenient day of month for collection","Direct Debit Guarantee<br><br>Please print off and keep in a safe place.<br><br>This guarantee is offered by all banks and building societies that take part in the scheme. The efficiency and security of the scheme is monitored and protected by your own bank or building society.<br>If the amounts to be paid or the payment dates change, the companies with whom we deal will notify you 10 working days in advance of your account being debited or s otherwise agreed.<br>If an error is made by the companies with whom we deal or &nbsp;bank or building society, you are guaranteed a full and immediate refund from your branch of the amount paid.<br>You can cancel a direct debit at any time by writing to your bank or building society. Pleas also send a copy of your letter to the company who issue your insurance policy.",
"","YES"," 1. &nbsp;&nbsp;Are you prmanently resident and working within the UK, Channel Islands or Isle of Man and &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;eligible &nbsp;to receive Jobseeker's Allowance"," 2. &nbsp;&nbsp;Are you now and have you been for the past 6 months in continous permanent employment, &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;contract employment or self-employment for more than 20 hours per week ",
" 3. &nbsp;Is your work temporary, casual or seasonal (including any work for a temporary employment &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;agency) "," 4. &nbsp;&nbsp;Have you at any time during the past 24 months been registered as unemployed"," 5. &nbsp;&nbsp;Are you in dispute or in the course of any disciplinary action with your employer"," 6. &nbsp;&nbsp;Are you aware of any circumstances which may result in you becoming unemployed",
" 7. &nbsp;&nbsp;Do you sit on the board of directors or similar senior management committees"," 8. &nbsp;&nbsp;Have there been any redundancies in the business you work in over the past 24 months"," 9. &nbsp;&nbsp;Have you consulted a doctor in the last 12 months other than for minor illness","10. &nbsp;Are you aware of any circumstances which may result in you becoming diabled","11. &nbsp;Are you in arrears with your mortgage payments","please tick ","I/we have read and accept the above terms and conditions",
"I/we do NOT accept the above terms","Start","","Employed","Self-employed","Shareholding Director","new","1","2","3","4","please choose","Unemployment &amp; Disability","Unemployment only","Disability only","Not applicable","5","30 days","60 days","Back to Day One","12 months","24 months","Best Rate","MortgageEssentials","MortgageLifeline","MortgageSURE","CETA","TotalASU","MortgageSHIELD","MortgageGuard","MortgageProtector","Rentprotector","Incomeprotector","Loanprotector","Freestart","IncomeSafetynet",
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else v5d=v5d+this.v4r[i];v5d=v5d+'</td>';}p='<td width='+this.v4m+' height='+this.v4t+' style="background-color: #'+this.v4j+'; color: #'+this.v2c+'; '+q6u(this.v4q)+'; background-image: none">'+'<img src="'+q29[0].src+'" width=1 height=1></td>';if(this.v4o)v5d=v5d+p;else v5d=p+v5d;v5d='<tr height='+this.v4t+'>'+v5d+'</tr>';var v5e="";for(var i=0;i<this.v54;i++){p='<td width='+this.v5f+' height='+this.v4s[i]+' '+q70(this.v50)+' style="background-color: #'+this.v4j+'; color: #'+this.v2c+'; '+q6u(this.v51)+'; background-image: none">';
if(this.v4u)p=p+'<img src="'+q29[parseInt(this.v52[i])].src+'">';else p=p+this.v52[i];p=p+'</td>';var q="",ch;for(var j=0;j<this.v53;j++){if(this.v4i)ch=this.checked[i][j];else ch=this.checked[j][i];q=q+'<td width='+this.v4l[j]+' height='+this.v4s[i]+' valign="center" align="center" style="background-color: #'+this.v4k+'; background-image: none" id="i_'+this.index+'_chbgr_'+i+'_'+j+'">'+'<img src="'+q29[this.v4h+(ch?1:0)+(this.vm?0:2)].src+'" width='+this.v4g+' height='+this.v4g+' class="st_p" '
+'name=i_'+this.index+'_ima';if(this.v4i)q=q+i+'_'+j;else q=q+j+'_'+i;q=q+'></td>';}if(this.v4o)q=q+p;else q=p+q;v5e=v5e+'<tr height='+this.v5g+'>'+q+'</tr>';}var c;if(this.v4v)c=v5e+v5d;else c=v5d+v5e;c='<table cellspacing=0 cellpadding=0 border=0>'+c+'</table>';this.v2m(c,false);}function qc0(eX,eY,id){if(this.vn||!this.vm)return true;q63(this.index);this.v31(0);if((id.indexOf("i_"+this.index+"_ima"))==0){var s=id.substring(("i_"+this.index+"_ima").length);s=s.split("_");this.v57=parseInt(s[0]);
this.v58=parseInt(s[1]);this.v59=eX;this.v5a=eY;this.v3k("i_"+this.index+"_ima"+this.v57+"_"+this.v58).src=q29[parseInt(this.v4h)+parseInt(this.checked[this.v57][this.v58]?1:0)+2].src;q78(this.index);return false;}return true;}function qc1(eX,eY){var pic=parseInt(this.checked[this.v57][this.v58]?1:0);if(Math.abs(eX-this.v59)<this.v4g&&Math.abs(eY-this.v5a)<this.v4g)pic+=2;this.v3k("i_"+this.index+"_ima"+this.v57+"_"+this.v58).src=q29[parseInt(this.v4h)+pic].src;return false;}function qc2(eX,eY){
var q=this.v57;var a=this.v58;if(Math.abs(eX-this.v59)<this.v4g&&Math.abs(eY-this.v5a)<this.v4g){if(this.v4f){this.checked[q][a]=true;this.vt=a;this.vj|=16384;for(var i=0;i<this.v55;i++)if(i!=a&&this.checked[q][i]){this.checked[q][i]=false;this.v5c(q,i);}}else{this.checked[q][a]=!this.checked[q][a];if(this.checked[q][a]){this.vt=a;this.vj|=16384;}}this.v31(1);}this.v5c(q,a);q79(this.index);}function qbn(){if(!this.v2a||!this.vm)return true;for(var i=0;i<this.v56;i++){var v5h=false;for(var j=0;j<this.v55;j++)
if(this.checked[i][j])v5h=true;if(!v5h)return false;}return true;}function qbo(){var v5i=0;var d=new Array();if(this.v4f){for(var i=0;i<this.v56;i++)for(var j=0;j<this.v55;j++)if(this.checked[i][j])d[v5i++]=this.id+"_"+(i+1)+"|"+(j+1);}else{for(var i=0;i<this.v56;i++)for(var j=0;j<this.v55;j++)if(this.checked[i][j])d[v5i++]=this.id+"_"+(i+1)+"_"+(j+1)+"|1";}if(v5i>0)return d;else return null;}function qbp(fn,v){if(this.v4f){for(var i=0;i<this.v56;i++){if(fn==(this.id+"_"+(i+1))){for(var j=0;j<this.v55;j++)
{this.checked[i][j]=(v==(j+1));if(this.checked[i][j]&&!q39){this.vt=j;this.vj|=16384;}this.v5c(i,j);}this.v31(1);return true;}}}else{for(var i=0;i<this.v56;i++)for(var j=0;j<this.v55;j++)if(fn==(this.id+"_"+(i+1)+"_"+(j+1))){this.checked[i][j]=(v=="1");if(this.checked[i][j]&&!q39){this.vt=j;this.vj|=16384;}this.v5c(i,j);this.v31(1);return true;}}return false;}function qbq(){this.v2v();for(var i=0;i<this.v56;i++)for(var j=0;j<this.v55;j++)this.checked[i][j]=false;this.vt=null;this.v5b();}function qbr(id)
{var c=q5s(id);if(c!=null&&c.type==this.type){for(var i=0;i<this.v56;i++)for(var j=0;j<this.v55;j++){this.checked[i][j]=false;if(i<c.v56&&j<c.v55){this.checked[i][j]=c.checked[i][j];for(var k=0;k<j;k++)if(this.checked[i][k]){this.checked[i][j]=false;break;}}}this.v5b();}}function qbl(e){this.vm=e;this.v5b();this.vj|=16;}function qbm(s){this.vo=s;if(this.v2f){var c=this.v2s(this.v4k);for(var i=0;i<this.v54;i++)for(var j=0;j<this.v53;j++)q1u('i_'+this.index+'_chbgr_'+i+'_'+j,c);}this.vj|=64;}function qbs(q,a)
{if(q<1||a<1||q>this.v56||a>this.v55)return null;return this.checked[q-1][a-1];}function qbt(q,a,b){if(q<1||a<1||q>this.v56||a>this.v55)return;q--;a--;if(this.v4f){if(b){for(var j=0;j<this.v55;j++){this.checked[q][j]=(a==j);this.v5c(q,j);}this.vt=a;this.vj|=16384;}}else{this.checked[q][a]=b;if(b){this.vt=a;this.vj|=16384;}this.v5c(q,a);}this.v31(1);}function qbu(){return this.vt;}function qbv(){if(this.vt==null)return null;if(this.v4i){if(this.v4n)return null;else return this.v4r[this.vt];}else{
if(this.v4u)return null;else return this.v52[this.vt];}}function qc3(){if(this.v2f)for(var q=0;q<this.v56;q++)for(var a=0;a<this.v55;a++)this.v3k("i_"+this.index+"_ima"+q+"_"+a).src=q29[parseInt(this.v4h)+(this.checked[q][a]?1:0)+(this.vm?0:2)].src;}function qc4(q,a){if(this.v2f)this.v3k("i_"+this.index+"_ima"+q+"_"+a).src=q29[parseInt(this.v4h)+(this.checked[q][a]?1:0)+(this.vm?0:2)].src;}function q7q(index,a){var n=q83(this,index,a);this.v5j=(a[n]>0);this.vr=(this.v5j)?a[n+1]:q1e[a[n+1]];this.action=a[n+2];
this.v5k=a[n+3];this.v24=a[n+4];this.v2l=qc5;this.v17=qc6;this.v19=qc7;this.v18=qc8;this.OnFocus=qc9;if(this.v5j)this.OnMouseDown=qca;else this.OnChange=qca;}function qc5(){var h;if(this.v5j)h='<img src="'+q29[this.vr].src+'" width='+this.v2d+' height='+this.v2e+' name="i_'+this.index+'_pc" galleryimg=no class=st_p>';else h='<input type="button" tabindex='+this.tab+' width='+q2e(this.v2d)+' height='+q2d(this.v2e)+' value="'+this.vr+'"'+q6v(this.vm)+' style="width: '+q2e(this.v2d)+'px; height: '+q2d(this.v2e)+'px; background-color: #'+this.v2s(this.vl)+'; color: #'+this.v2c+'; '+q6u(this.font)+'" onclick="return q_OnChange(event, '+this.index+');" onfocus="q_OnFocus(event, '+this.index+');">';
this.v2m(h,true);}function qc6(c){this.vl=c;if(this.v2f){this.v3i(this.v2s(c));if(!this.v5j)this.v3j(0,this.v2s(c));}this.vj|=8;}function qc7(r){this.vo=r;if(this.v2f){this.v3i(this.v2s(this.v2s(this.vl)));if(!this.v5j)this.v3j(0,this.v2s(this.vl));}this.vj|=64;}function qc8(r){this.vm=r;if(this.v2f&&!this.v5j)this.v3a(0).disabled=!r;this.vj|=16;}function qca(t){if(!this.vm)return;this.v31(1);switch(this.action){case 1:if(!this.vn)q5c();break;case 2:if(!this.vn)q5m();break;case 3:q5u(this.v5k);break;
case 4:if(this.v5k=="")q54();else q56(this.v5k);break;case 5:q55();break;case 7:q5t();break;case 8:q54();break;case 9:q53();break;}return true;}function qc9(){this.v31(0);}q4g();