Myself Form December1 Plan

Selected Plan: December 1

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Do you have any current medical condition that requires ongoing treatment?

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I declare that to the best of my knowledge, I and any other person to be insured in this application have provided the accurate information at the point of registration and the insurer is indemnified should a claim arise due to information withheld from this application.

I understand that certain conditions such as maternity care, intensive care, surgeries, optical care and psychiatric care may be subject to a condition specific waiting period specified on the Benefit Table and therefore will not be covered from the beginning of the policy

Selected Plan: December 1

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Selected Plan: December 1

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