Cover · free template

Life Insurance Application

Three-page life cover application: applicant and cover requested, health and family history, lifestyle and occupation, beneficiaries and declarations.

A ready-to-use insurance form for small teams who need a reliable intake process: 33 questions, 3 pages, 4 conditional rules.

Questions
33
Pages
3
Layouts
classic · card
Time to complete
≈ 12 min
Conditional rules
4
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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

About you

Include your country code.

The cover you are applying for

Is the cover for one person or two?
What type of cover?
Is it linked to a mortgage?

This template runs as a straight sequence — no branching rules.

Compliance checklist

Ready to publish
  • Payment items priced — passingEvery payment question charges a real amount, so a submission always records a payment.
  • Conditional logic resolves — passingEvery rule points at a question or page that exists in this template.
  • Financial disclaimer present — passingThis form does not provide financial, tax or legal advice. Any figures shown are indicative only and are not an offer of credit or a guarantee of terms. Please seek advice from a regulated adviser before making a decision.
  • Question labels unique — passingLogic and exports address questions by label, so duplicates are ambiguous.

What happens after submit: nothing is stored in this preview. On your own copy, every response triggers an instant email notification and lands in your response dashboard, ready to export or forward.

Happy with it? Take a copy into your workspace — every question, rule and setting comes with it.

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.

  1. 1Press “Use this template” — a fresh copy of Life Insurance Application lands in your workspace, ready to edit.
  2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
  3. 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.
  4. 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.
  5. 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.

About this template

A life application is a long form by nature, so this three-page version is arranged so the easy parts come first and nobody abandons it on question four. The first page covers the applicant and what they are asking for: personal details, whether cover is for one person or two, the amount and term, the type of cover, and whether it is linked to a mortgage. The second page is the health section: height and weight, smoking and vaping, alcohol, current conditions and medication, hospital admissions, and immediate family history with ages, asked plainly rather than in medical language. The third page covers occupation, travel and hazardous pursuits, then beneficiaries or a trust, existing cover being replaced, and the declarations. Every health question exists because an insurer needs it for underwriting; the form does not interpret answers, and it never suggests that an answer will lead to a particular decision. Acceptance, pricing and any exclusion are decided by the insurer after underwriting, which may include a medical report, and the copy says so before anyone starts.

What this form asks

Every question is editable — rename it, make it optional, or delete it entirely.

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

33 questions in total.

Example of a completed life insurance application form

This sample shows the personal and lifestyle details an applicant provides when applying for cover.

Full legal name
Patrick Duffy
Date of birth
2 August 1985
Amount of cover you want
150000
Term in years
20
What type of cover?
Level term
Have you smoked or vaped in the last 12 months?
No
Any conditions you are being treated for, or have been?
None
Your occupation
Secondary school teacher
Beneficiaries, and their relationship to you
Fiona Duffy, spouse

Sample data — no real people, addresses or records are shown.

How the form changes as it's filled in

This template ships with 4 conditional rules, grouped into 4 behaviours driven by 4 questions. Everything below is already set up — edit or delete any rule once the template is in your workspace.

Driven by “Have you smoked or vaped in the last 12 months?”

  • Makes answers required

    If “Have you smoked or vaped in the last 12 months?” is Yes, “What do you use, and how much per day?” becomes required before the form can be submitted.

Driven by “Are you taking any medication?”

  • Makes answers required

    If “Are you taking any medication?” is Yes, “Which medication, and what for?” becomes required before the form can be submitted.

Driven by “Do you take part in any hazardous activities?”

  • Makes answers required

    If “Do you take part in any hazardous activities?” is Yes, “Which activities, and how often?” becomes required before the form can be submitted.

Driven by “Is this replacing cover you already have?”

  • Makes answers required

    If “Is this replacing cover you already have?” is Yes, “Which policy, and with which insurer?” becomes required before the form can be submitted.

Set it up step by step

  1. 1

    Put cover before health

    People finish the sections they understand; asking what they want first buys the goodwill the health page spends.

  2. 2

    Turn on save and resume

    The health page is where applications are abandoned, and being able to come back with a repeat prescription to hand fixes most of it.

  3. 3

    Explain why health questions are asked

    One neutral line above the page — that underwriting needs them — reduces both abandonment and vague answers.

  4. 4

    Never hint at an outcome

    Keep every answer neutral in tone; a form that implies a decision creates an expectation the insurer has to unpick.

Mistakes to avoid

  • Suggesting that an answer will or will not affect acceptance, which is the insurer's decision after underwriting.
  • Using medical terminology in health questions, which produces blank fields rather than accurate ones.
  • Forgetting the replacement-cover question, so an applicant cancels existing cover before the new policy is accepted.

What it pairs with

Most teams don't run this form on its own. These are the forms and systems it sits next to.

What to do with the responses

Pass completed applications to underwriting, tell the applicant what happens next and how long it usually takes, and never advise cancelling existing cover before acceptance.

Works in both layouts

Browse classic templatesBrowse card templates

Forms that overlap this one

These pages cover the same subject ground as the life insurance application, matched on the words people actually search for.

Privacy & compliance

This form collects health information. Keep access limited to the people who need it, turn on encrypted answers for the clinical questions, and set a retention window so records don't sit in the dashboard forever.

Frequently asked questions

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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