Life Insurance Application — shared by the community
Sam B. shared this 33-question build with 4 conditional rules already wired up. Test it below, then take a copy.
A ready-to-use insurance form for small teams who need a reliable intake process: 33 questions, 3 pages, 4 conditional rules.
- Shared by
- Sam B. · Customer success
- Questions
- 33
- Replies
- 8
- Copies taken
- 277
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Live preview and test console
This is the real form. Answer it to test the flow — nothing is sent or stored.
Page 1 of 3 — You and the cover you want
This template runs as a straight sequence — no branching rules.
Works for you? Take Sam B.'s copy into your own workspace — questions, rules and settings included.
Who this template is for
Life Insurance Application is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.
- Small teams who need a reliable intake process working in insurance.
- Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
- Anyone replacing chasing missing details over email with one structured record per enquiry.
- Respondents are the people you send it to — the form asks them 33 questions across 3 screens.
- Mobile-heavy audiences, thanks to the one-question-per-screen card layout.
Why this form is useful
It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.
- 23 questions are required, so submissions arrive complete instead of needing a follow-up email.
- It collects a verified email address so replies and confirmations land.
- It captures a phone number for urgent follow-up.
- It records a signature you can keep as proof of agreement.
- It pins the request to a specific date.
- It captures a full postal address.
- It allows multiple selections without free text.
- It captures a numeric value you can filter and sort on.
How to use this template
From copy to live form is a few minutes of work, and every step is reversible.
- 1Press “Use this template” — a fresh copy of Life Insurance Application lands in your workspace, ready to edit.
- 2Rename or delete any question, and change what is required. Nothing here is fixed.
- 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
- 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
- 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.
Logic and conditions blueprint
Exactly how this form behaves as it is answered — 4 conditional rules ship with it.
- Features conditional validation: if “Have you smoked or vaped in the last 12 months?” is Yes, “What do you use, and how much per day?” becomes mandatory before the form can be sent.
- Features conditional validation: if “Are you taking any medication?” is Yes, “Which medication, and what for?” becomes mandatory before the form can be sent.
- Features conditional validation: if “Do you take part in any hazardous activities?” is Yes, “Which activities, and how often?” becomes mandatory before the form can be sent.
- Features conditional validation: if “Is this replacing cover you already have?” is Yes, “Which policy, and with which insurer?” becomes mandatory before the form can be sent.
- All 4 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.
What this form asks
Page 1 — You and the cover you want
- Full legal namerequired
- Date of birthrequired
- Home address
- Contact numberrequired
- Email addressrequired
- Is the cover for one person or two?required
- Amount of cover you wantrequired
- Term in yearsrequired
- What type of cover?required
- Is it linked to a mortgage?required
Page 2 — Health and family history
- Height in centimetresrequired
- Weight in kilogramsrequired
- Have you smoked or vaped in the last 12 months?required
- What do you use, and how much per day?
- Alcohol units in a typical week
- Any conditions you are being treated for, or have been?
- Are you taking any medication?required
- Which medication, and what for?
- Any hospital admissions or operations in the last five years?
- When did you last see a doctor?required
- Has a parent, brother or sister had a serious illness before 65?
Page 3 — Work, beneficiaries and declarations
- Your occupationrequired
- Employer name
- Does your work involve heights, machinery or hazardous materials?required
- Do you take part in any hazardous activities?required
- Which activities, and how often?
- Do you travel outside your home country for more than four weeks a year?required
- Beneficiaries, and their relationship to yourequired
- Should the policy be written in trust?required
- Is this replacing cover you already have?required
- Which policy, and with which insurer?
- Declarationsrequired
- Signaturerequired
Conditional logic in this build
- When “Have you smoked or vaped in the last 12 months?” is Yes, require “What do you use, and how much per day?”.
- When “Are you taking any medication?” is Yes, require “Which medication, and what for?”.
- When “Do you take part in any hazardous activities?” is Yes, require “Which activities, and how often?”.
- When “Is this replacing cover you already have?” is Yes, require “Which policy, and with which insurer?”.
Questions about this shared form
Is this a quote or an application?
An application. For indicative pricing the Insurance Quote Request Form is the shorter route; this form collects what underwriting needs to make a decision.
Does submitting it mean the applicant is covered?
No. The declarations say so plainly: cover starts only when the insurer accepts the application, and there may be underwriting steps in between.
Why ask about family history?
Insurers use it in underwriting. The question asks for relationship, illness and age plainly, and no answer on the form leads to an automatic outcome.
How should health answers be stored?
Treat submissions as sensitive: restrict access, avoid forwarding them to shared inboxes, and say above the form who reads them and for how long they are kept.
Is the Life Insurance Application template free to use?
Yes. You can preview and test Life Insurance Application on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.
What does the Life Insurance Application template ask for?
It asks 33 questions across 3 pages, 23 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.
Can I edit the Life Insurance Application form after copying it?
Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.
How does the conditional logic in this insurance form work?
4 conditional rules ship with the template: Features conditional validation: if “Have you smoked or vaped in the last 12 months?” is Yes, “What do you use, and how much per day?” becomes mandatory before the form can be sent. Features conditional validation: if “Are you taking any medication?” is Yes, “Which medication, and what for?” becomes mandatory before the form can be sent. Features conditional validation: if “Do you take part in any hazardous activities?” is Yes, “Which activities, and how often?” becomes mandatory before the form can be sent. All rules are editable in the Logic tab.
Where do responses to the Life Insurance Application form go?
Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.
Can I embed the Life Insurance Application form on my own website?
Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.
Is the signature on this form legally usable?
The template captures a drawn signature and stores it with the submission, along with the timestamp, so you keep evidence of who agreed and when. Whether that is sufficient depends on your jurisdiction and the agreement itself.
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