Title
                                
                                
                            
                         
                        
                        
                            Date of birth
                            
                            
                             
                             
                        
                        
                            Do you smoke?     No    Yes
                            
                        
                        
                        
                        
                        
                            
                                
                                    App. 2: Title
                                    
                                
                             
                            
                            
                                App. 2: Date of birth
                                
                                
                                
                            
                            
                         
                        
                        
                        
                        
                        
                            Type of insurance
                            
                        
                        
                            Type of cover
                            
                        
                        
                            Amount of cover
                            
                        
                        
                            Type of premium
                            
                        
                        
                             
			                
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