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travel insurance that includes pre existing medical conditions
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Life Assurance

'High Street' types of insurers will generally will not provide life assurance that includes a pre-existing medical condition. You need a specialist policy that is available through us.

This kind of policy is relevant for people who may have, for example:diabetes, heart conditions, hepatitis, cancer, HIV/AIDS, lupus syndrome, Marfan syndrome, weight problems, depression, high blood pressure (hypertension), and respiritory disorders.

There are five types of policy available. Clicking on the following links will open up information about each, in a separate window: Level term life assurance, Decreasing term life assurance, Whole of Life cover, Family Income Benefit, Gift Inter Vivo. The information in these guides is provided as an illustration only and is as accurate as possible.

An indicative quotation will normally be obtained for you within a matter of days without the need for a medical. If the indication is acceptable to you, the Underwriters will then ask for permission ton contact your doctor. Final acceptance terms may then be offered.

Please complete the form below with as much detail as possible. Thank you.

ILLUSTRATION OPTIONS
Do you want single or joint cover?
PERSONAL DETAILS
First life assured
Second life assured
Title
If other, please specify
Surname
Forename
Gender
Date of birth (dd/mm/yy)
Full address
Tel
E mail
Have you smoked or used any tobacco or nicotine product in the last 12 months? Please note, we may require a test to confirm your non-smoking status.
If yes, what is your average weekly consumption? (eg amount and type: 100 ciagarettes, 4ozs pipe tobacco, 20 cigars)
What is your height?
ft ins OR
cms
ft ins OR
cms
What is your weight?
st ozs OR
kgs
st ozs OR
kgs
PLAN DETAILS
Type of policy required
Terminal illness option
Sum assured or annual income if FIB
OR monthly premium payable
Policy term
years
years
If joint life, should the sum assured be payable upon:
Premium payment payable
PREVIOUS COVER
Has any proposal for life cover been declined or postponed?
If yes, please give us the date
Company that declined/postponed cover
Reason why (if known)
If postponed, for how long?
HAZARDOUS ACTIVITES
Sports/passtimes - please provide full details if you take part in any hazardous sports/passtimes
Occupation (please provide further, full details if you work at heights, under ground, under water or offshore)
HEALTH CONDITION 1
Name of condition, illness or injury
Date diagnosed
Treatments, including dates
Medication, including name and quantity
HEALTH CONDITION 2
Name of condition, illness or injury
Date diagnosed
Treatments, including dates
Medication, including name and quantity
HEALTH CONDITION 3
Name of condition, illness or injury
Date diagnosed
Treatments, including dates
Medication, including name and quantity
HEALTH CONDITION 4
Name of condition, illness or injury
Date diagnosed
Treatments, including dates
Medication, including name and quantity
FURTHER INFORMATION
Please give us any other information you think might be relevant

 

 


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