Health Questionnaire (Joint)

1Notices
2Personal Details
3Children / Dependants
4GP Contact Details
5Private Medical Information
6Hobbies & Pastimes
7Occupation
8Medical History
9Additional Medical Details
10Bank & Trustee Details
The following information will be used by a Life Insurance provider to underwrite your application for life insurance, critical illness and/or income protection insurance. All information is kept private and confidential. We will not share this information with anyone without your permission. If there are any questions you would prefer to answer direct to your provider, please mark ‘Private’ beside the specific question. We will provide the necessary contact details to allow you to complete your application. It's very important you answer every question on the application truthfully and accurately to ensure all valid claims are paid to protect you and your dependents. If you don't, it could mean a claim may not be paid and your policy may be cancelled. Your provider won't always write to your doctor to confirm your answers.