Access and manage your claims
1. Do you engage in any sports(s) or occupation of a dangerous or hazardous nature such as motor racing, scuba / skin diving, parachuting, military (excluding NS) or private flying other than as a fare paying passenger, etc.?
2. Has any of your application / reinstatement for life, critical illness, accident, disability income, medical insurance ever been declined, postponed, or accepted with special terms (eg: extra premium loading or exclusion imposed)?
3. a) Have you ever used addictive drugs, narcotics, glue sniffing or been treated for drug addiction?
b) Have you ever had or been treated for alcoholism?
4. Do you drink wine, beer or other alcoholic beverages?
5. Have you ever smoked cigarettes in the last 12 months?
6. a) Have you received any medical advice, counselling or treatment in connection with sexually transmitted disease, AIDS Related Complex or any other AIDS related condition.
b) Have you ever had HIV testing done? If yes, please state the reason and its results
7. In the past 3 months, have you ever had any of the following symptoms for more than one week continuously: Fatigue, weight loss, enlarged node(s) or unusual skin lesion(s)?
8. In the past 5 years, have you ever undergone or been advised to undergo any medical investigation(s) carried out on the recommendation of a doctor such as X-ray, Ultrasound, Heart scan, CT scan, Biopsy, Endoscopy, Gastroscopy, Colonoscopy, Surgical operation, etc.?
9. Have you EVER had or been told you had or been treated
a) Asthma, coughing with blood, pneumonia, tuberculosis, bronchitis, breathing discomfort or breathlessness and / or any other lung disease / disorder?
b) Rheumatic fever, high blood pressure, heart murmur, heart attack, coronary artery disease, mitral valve prolapse, or other heart valve disorder, irregular or fast heart rate, chest discomfort or chest pain, and / or any disease or disorder of the heart or blood vessels?
c) Renal / bladder stone(s), albumin/protein in urine, blood or sugar in urine, urine infection or any other disorder of the kidney(s), bladder, urinary or genital organs?
d) Epilepsy, fits, stroke, paralysis, dementia, Parkinson's disease, multiple sclerosis, motor neurone disease, weakness of limbs, polio, fainting spells, prolonged headache, anxiety, depression, or any other nervous or mental disorder(s) or disease of the brain?
e) Diabetes, thyroid disorder(s), or any other endocrine disorder(s)
f) Gastritis, ulcer, blood in stools, fistula, hernia, irritable bowel syndrome, or any other disease / disorder of the stomach or bowel
g) Hepatitis B carrier or any form of hepatitis, jaundice, liver disorder or gall bladder disorder
h) Ear discharge, nose bleeding, double vision, impaired sight, hearing or speech, or any other disorder of the ear(s), eye(s), nose, or throat?
i) Slipped disc, back pain, gout, any form of arthritis, joint pain or deformity, and / or any disease/disorder of the muscles, spine, limbs or joints or severe injury?
j) Anaemia, any other disorders of the blood, or advised to abstrain from donating or received blood transfusion?
k) Cancer, tumour(s), cyst(s) or growth(s) of any kind?
l) Congenital anomalies, physical disability or any other illness, disorder, operations, hospital admission, accident or injury not mentioned above?
10. a) Have you ever been to any doctor for a Pap Smear (cervical smear)?
b) Have you ever had any abnormal pap smear test or been told by any doctor to have a repeat pap smear within 6 months?
c) Have you ever been found to have or are you aware of any breast cyst(s) / lump(s) / nodule(s) or any other disease or disorder of the breast(s)?
d) Have you ever suffered from irregular, painful or unusually heavy menstruation, fibroid(s), cyst(s) or any other disorder involving the female organ(s)?
11. a) Were there any complication(s) noted during any of your pregnancy such as gestational diabetes, hypertension etc.?
b) Are you currently pregnant?
WARNING:If a material fact is not disclosed in this proposal, any policy issued may not be valid. If you are in doubt as to whether a fact is material, you are advised to disclose it. This includes any information that you may have provided to the Financial Services Consultant(s)/ Insurance Representative(s) but was not included in the proposal. Please check to ensure you are fully satisfied with the information declared in this proposal. Additionally and without prejudice to the parties' rights and obligations whether under law or otherwise, you must continue to disclose any and all material facts that may arise or which have changed from the information you had provided.