Illustration Request for a Preserve & Profit Bond

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

	Personal Details
	*Date of Birth Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec (minimum age 18) Sex Male Female Product Details *Amount to be invested (in £s) (minimum £5,000)   (Minimum £2,500 if you have a maturing Windsor Life policy or wish to top-up your existing Preserve & Profit Bond) Would you like an income from your investment? Yes No
	Income Amount £ (minimum £50) or Income as a % 1 2 3 4 5 % (maximum 5%) Income Frequency Annually Quarterly Half-Yearly Monthly
	Would you like to insure another life on the same policy? Yes No
	If you would, please enter their personal details: Title Mr Mrs Ms Miss Other Other Surname Forename(s) Date of Birth Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec (minimum age 18) Sex Male Female Payment to be made on the death of whom? 1st Death 2nd Death
	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.