Health Disclosure Form

This health questionnaire is designed to help your adviser obtain the information needed to assess your eligibility for insurance products. The questions are based on standard UK insurance underwriting requirements.

It is very important that you answer all questions honestly and to the best of your knowledge. Failure to disclose material information — whether by omission or misrepresentation — could result in your policy being voided, a claim being declined, or any benefit paid being reduced.

This duty of disclosure applies both at the time of application and, if there is a change in your health between completing this form and the commencement of the policy, you should inform your adviser immediately.

The information you provide in this form will be treated in the strictest confidence. It will be used solely for the purpose of arranging your insurance and will only be shared with insurers and reinsurers as necessary to process your application. Your data will be handled in accordance with the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018.

Please read our Privacy Notice before completing this form. By submitting this form you confirm that you have read, understood, and consent to your data being processed as described.

If you are unsure how to answer any question, please ask your adviser before proceeding. Do not leave any question unanswered — if a question does not apply to you, please state 'Not applicable' or answer 'No' as appropriate.

This form is not a medical questionnaire and does not constitute medical advice. Please consult your GP or a qualified medical professional if you have concerns about your health.