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3.11.25.68  Public Scan

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Submitted URL: https://theinsurancesurgery.exvn.com/page.cfm?article=0x373e056b1fb52d937c1ae00f839442b5.0.190830
Effective URL: https://the-insurance-surgery.uk/p/bp/index.php?utm_source=merrehill&utm_medium=email&utm_campaign=5303117-20
Submission: On March 28 via manual from IN — Scanned from GB

Form analysis 1 forms found in the DOM

POST /p/bp/index.php

<form id="enquiryform" action="/p/bp/index.php" method="post">
  <input type="hidden" name="recid" value="">
  <input type="hidden" name="sid" value="">
  <input type="hidden" name="sendid" value="">
  <input type="hidden" name="source" value="Keyman">
  <h2 align="center" style="margin: 10px; color: #242e64;">Let's Get You Covered<span style="color: #d1387b;">.</span></h2>
  <h2 align="center" style="margin: 10px; color: #242e64; font-size: 1.2em;">Compare Life Insurance Quotes<span style="color: #d1387b;">.</span></h2>
  <div class="row">
    <div class="col-12 form-group">
      <div class="input-group">
        <div class="input-group-prepend">
          <span class="input-group-text" id="inputGroupPrepend"><svg class="svg-inline--fa fa-user fa-w-14" aria-hidden="true" focusable="false" data-prefix="fa" data-icon="user" role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 448 512"
              data-fa-i2svg="">
              <path fill="currentColor"
                d="M224 256c70.7 0 128-57.3 128-128S294.7 0 224 0 96 57.3 96 128s57.3 128 128 128zm89.6 32h-16.7c-22.2 10.2-46.9 16-72.9 16s-50.6-5.8-72.9-16h-16.7C60.2 288 0 348.2 0 422.4V464c0 26.5 21.5 48 48 48h352c26.5 0 48-21.5 48-48v-41.6c0-74.2-60.2-134.4-134.4-134.4z">
              </path>
            </svg><!-- <i class="fa fa-user"></i> --></span>
        </div><input class="form-control" type="text" name="name" placeholder="Name" required="">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-12 form-group">
      <div class="input-group">
        <div class="input-group-prepend">
          <span class="input-group-text" id="inputGroupPrepend"><svg class="svg-inline--fa fa-building fa-w-14" aria-hidden="true" focusable="false" data-prefix="fa" data-icon="building" role="img" xmlns="http://www.w3.org/2000/svg"
              viewBox="0 0 448 512" data-fa-i2svg="">
              <path fill="currentColor"
                d="M436 480h-20V24c0-13.255-10.745-24-24-24H56C42.745 0 32 10.745 32 24v456H12c-6.627 0-12 5.373-12 12v20h448v-20c0-6.627-5.373-12-12-12zM128 76c0-6.627 5.373-12 12-12h40c6.627 0 12 5.373 12 12v40c0 6.627-5.373 12-12 12h-40c-6.627 0-12-5.373-12-12V76zm0 96c0-6.627 5.373-12 12-12h40c6.627 0 12 5.373 12 12v40c0 6.627-5.373 12-12 12h-40c-6.627 0-12-5.373-12-12v-40zm52 148h-40c-6.627 0-12-5.373-12-12v-40c0-6.627 5.373-12 12-12h40c6.627 0 12 5.373 12 12v40c0 6.627-5.373 12-12 12zm76 160h-64v-84c0-6.627 5.373-12 12-12h40c6.627 0 12 5.373 12 12v84zm64-172c0 6.627-5.373 12-12 12h-40c-6.627 0-12-5.373-12-12v-40c0-6.627 5.373-12 12-12h40c6.627 0 12 5.373 12 12v40zm0-96c0 6.627-5.373 12-12 12h-40c-6.627 0-12-5.373-12-12v-40c0-6.627 5.373-12 12-12h40c6.627 0 12 5.373 12 12v40zm0-96c0 6.627-5.373 12-12 12h-40c-6.627 0-12-5.373-12-12V76c0-6.627 5.373-12 12-12h40c6.627 0 12 5.373 12 12v40z">
              </path>
            </svg><!-- <i class="fa fa-building"></i> --></span>
        </div><input class="form-control" type="text" name="company" placeholder="Company Name">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-12 form-group">
      <div class="input-group">
        <div class="input-group-prepend">
          <span class="input-group-text" id="inputGroupPrepend"><svg class="svg-inline--fa fa-phone fa-w-16" aria-hidden="true" focusable="false" data-prefix="fa" data-icon="phone" role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512"
              data-fa-i2svg="">
              <path fill="currentColor"
                d="M493.4 24.6l-104-24c-11.3-2.6-22.9 3.3-27.5 13.9l-48 112c-4.2 9.8-1.4 21.3 6.9 28l60.6 49.6c-36 76.7-98.9 140.5-177.2 177.2l-49.6-60.6c-6.8-8.3-18.2-11.1-28-6.9l-112 48C3.9 366.5-2 378.1.6 389.4l24 104C27.1 504.2 36.7 512 48 512c256.1 0 464-207.5 464-464 0-11.2-7.7-20.9-18.6-23.4z">
              </path>
            </svg><!-- <i class="fa fa-phone"></i> --></span>
        </div><input class="form-control" type="text" name="telephone" placeholder="Telephone" required="">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-6 form-group"><label for="date_of_birth"><b>Date of Birth:</b></label>
      <div class="input-group">
        <div class="input-group-prepend">
          <span class="input-group-text" id="inputGroupPrepend"><svg class="svg-inline--fa fa-calendar fa-w-14" aria-hidden="true" focusable="false" data-prefix="fa" data-icon="calendar" role="img" xmlns="http://www.w3.org/2000/svg"
              viewBox="0 0 448 512" data-fa-i2svg="">
              <path fill="currentColor"
                d="M12 192h424c6.6 0 12 5.4 12 12v260c0 26.5-21.5 48-48 48H48c-26.5 0-48-21.5-48-48V204c0-6.6 5.4-12 12-12zm436-44v-36c0-26.5-21.5-48-48-48h-48V12c0-6.6-5.4-12-12-12h-40c-6.6 0-12 5.4-12 12v52H160V12c0-6.6-5.4-12-12-12h-40c-6.6 0-12 5.4-12 12v52H48C21.5 64 0 85.5 0 112v36c0 6.6 5.4 12 12 12h424c6.6 0 12-5.4 12-12z">
              </path>
            </svg><!-- <i class="fa fa-calendar"></i> --></span>
        </div><input class="form-control" type="text" name="date_of_birth" placeholder="DD/MM/YYYY" required="">
      </div>
    </div>
    <div class="col-6 form-group"><label for="smoke"><b>Do you smoke?</b></label><select class="form-control" name="smoke">
        <option disabled="" selected="" value="">Select an option</option>
        <option value="yes">Yes</option>
        <option value="no">No</option>
      </select></div>
  </div>
  <div class="row">
    <div class="col-12 form-group">
      <div class="input-group">
        <div class="input-group-prepend">
          <span class="input-group-text" id="inputGroupPrepend">@</span>
        </div><input class="form-control" type="text" name="email" placeholder="Email" required="">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-12 form-group">
      <div class="input-group">
        <div class="input-group-prepend">
          <span class="input-group-text" id="inputGroupPrepend"><svg class="svg-inline--fa fa-map-marker-alt fa-w-12" aria-hidden="true" focusable="false" data-prefix="fas" data-icon="map-marker-alt" role="img" xmlns="http://www.w3.org/2000/svg"
              viewBox="0 0 384 512" data-fa-i2svg="">
              <path fill="currentColor"
                d="M172.268 501.67C26.97 291.031 0 269.413 0 192 0 85.961 85.961 0 192 0s192 85.961 192 192c0 77.413-26.97 99.031-172.268 309.67-9.535 13.774-29.93 13.773-39.464 0zM192 272c44.183 0 80-35.817 80-80s-35.817-80-80-80-80 35.817-80 80 35.817 80 80 80z">
              </path>
            </svg><!-- <i class="fas fa-map-marker-alt"></i> --></span>
        </div><input class="form-control" type="text" name="postcode" placeholder="Postcode" required="">
      </div>
    </div>
  </div>
  <div class="row mb-3">
    <div class="col-12"><small id="emailHelp" style="color:#000 !important;" class="form-text">We will only use your details to contact you about your enquiry.</small></div>
  </div>
  <div class="row">
    <div class="col-12">
      <button type="submit" id="submit" class="form-control btn" style="background: #e71b7b; color: #ffffff;">Get your <b>FREE QUOTE</b> today</button>
    </div>
  </div>
  <div class="row">
    <div class="col-12">
      <p class="text-muted text-right"><a id="privacylink" href="#">Privacy Notice</a></p>
    </div>
  </div>
</form>

Text Content

PRIVACY NOTICE

×

The data controller is The Insurance Surgery .

The information you provide in this form will be collected by Merrehill Ltd on
behalf of the data controller. Where a submission is made for reasons other than
an enquiry about the products and services of the data controller, Merrehill may
decide not to further process the form data. In all other cases it will be
relayed to the data controller for the purpose of dealing with your enquiry.

You can contact us by writing to 2nd Floor Pickford Street Mill, Pickford
Street, Macclesfield, SK11 6JD , calling 0800 083 2829 or sending an email to
mike.dawson@theinsurancesurgery.co.uk.

Any personal data you provide in this form will be used to inform our authorised
staff of your enquiry so that they can take steps, at your request, to provide
the information you require to decide whether you wish to purchase our products
and services. The lawful basis for processing your personal data in this way is
provided in Article 6(1)(b) of the General Data Protection Regulation.

The information we collect is limited to your name, contact details, company
name and any other details requested in this form. These will be stored
according to our data protection policy and used as detailed above. A copy of
our policy is available upon request.

Close



LET'S GET YOU COVERED.


COMPARE LIFE INSURANCE QUOTES.




Date of Birth:

Do you smoke?Select an optionYesNo
@

We will only use your details to contact you about your enquiry.
Get your FREE QUOTE today

Privacy Notice


 
THE UK'S NO.1 SPECIALIST LIFE INSURANCE BROKER*


WHY CHOOSE US?

 * We search the UK's biggest insurers in minutes to get the cheapest quote.
 * Peace of mind cover for you and your family.
 * Free & impartial advice from our specialist team of experts.
 * No pushy sales people, we want the best for you.
 * Loved by our customers and 5* rated.
 * Price Match Promise guarantees you the best price *.

 



*Based on reviews on Trustpilot and Feefo versus our nearest specialist life
insurance competitor.

Company: The Insurance Surgery

2nd Floor Pickford Street Mill, Pickford Street, Macclesfield, SK11 6JD

Company No. 5137288 :: Registered in England and Wales

Registered Address: 2nd Floor Pickford Street Mill, Pickford Street,
Macclesfield, SK11 6JD