Illustration request for a Personal Pension Plan - Single Premium

Please enter the following details to enable us to provide your individual illustration which will be returned to you by post:

	Personal Details
	*National Insurance Number
	*Date of Birth	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec (minimum age 12)
	Sex	Male Female

	Are you employed or self-employed?	Employed Self-Employed

	Product Details
	*Premium Amount (in £s)	Gross (minimum £500)
	*Your expected retirement age	(maximum retirement age 75)

	You can distribute your investment between the following funds:
	Please enter the percentage splits you require
	American	%
	Balanced	%
	Deposit	%
	European	%
	Far East (including Japan)	%
	UK Fixed Interest	%
	Index Linked	%
	International	%
	Japan	%
	Managed	%
	Property	%
	Special Situations	%
	Tracker	%
	UK Equity	%
	Total	%

Please enter the correspondence address to which you would like the illustration sent:

	Title	Mr Mrs Ms Miss Other Other
	*Surname
	*Forename(s)
	*Address
	*Postcode
	Daytime Telephone Number
	*Email address
	If you already have a policy with Windsor Life, please enter your policy number(s) here:
	Policy number(s)

Data Protection Act 1998 The information which you provide on this form along with other information relating to you will be held by Windsor Life Assurance Company Ltd and used for general business purposes and, in particular, to provide the information you have requested. Details about you and your request may be passed to companies with which we have a business relationship, to confirm update and enhance their customer records, and to advise you (by post, telephone, or other electronic media) of any products and services that may interest you. If you do not wish to receive marketing information, please tick this box.