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    • The full application process should only take 5-10 minutes (you can also save and return to it). You must answer all of the questions yourself - you should not complete this application on behalf of someone else. It is important that you answer all of the questions fully, honestly and to the best of your knowledge. Otherwise, you risk your insurance being cancelled or risk a future claim being rejected or reduced.
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    • Have you ever suffered from or received treatment, advice or had investigations for any of the following:
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    • Have you ever suffered from or received treatment, advice or had investigations for any of the following:
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      Please select any that apply
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    • Details Person 2

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      Person 1

    • In the last 5 YEARS have you had any of the following?
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      Including slipped discs
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      Including: - Chronic Obsctructive Pulmonary Disease (COPD) - Sleep Apnoea - Emphysema
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      Including:
      - Reflux
      - Ulcers
      - Hernia
      - Crohn's Disease
      - Coeliac Disease
      - Barrett's Oesophagus
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      Including:
      - Vitamin B12 Deficiency
      - Blood Clots
      - Haemochromatosis
      - Anaemia
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      Including:
      - Endoscopy
      - Colonoscopy
      - MRI
      - CT
      - X-Ray
      - Biopsy
      - Blood Test
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      Person 2

    • In the last 5 YEARS have you had any of the following?
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      Including slipped discs
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      Including: - Chronic Obsctructive Pulmonary Disease (COPD) - Sleep Apnoea - Emphysema
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      Including:
      - Reflux
      - Ulcers
      - Hernia
      - Crohn's Disease
      - Coeliac Disease
      - Barrett's Oesophagus
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      Including:
      - Vitamin B12 Deficiency
      - Blood Clots
      - Haemochromatosis
      - Anaemia
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      Including:
      - Endoscopy
      - Colonoscopy
      - MRI
      - CT
      - X-Ray
      - Biopsy
      - Blood Test
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      Person 1

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      Including:
      - Tumour
      - Lymphoma
      - Hodgkin's Disease
      - Leukaemia
      - Melanoma
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      Including:
      - Heart Attack
      - Angina (including valves) or ciculatory system
      - Heart Abnormality
      - Cardiomyopathy
      - Cardiac Failure
      - Disease of the arteries or peripheral vascular disease
      - Heart Surgery
      - Heart Murmur
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      Including:
      - Mini Stroke or Transient Ischaemic Attack (TIA)
      - Aneurysm
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      Including:
      - Fits or Seizure
      - Alzheimer's
      - Dementia
      - Cerebral Palsy
      - Muscular Dystrophy
      - Motor Neurone Disease
      - Any disorder of the central nervous system
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