If you wish to declare a pre-existing medical condition, you must complete both sides of this form and send it to us. It must be submitted within 30 days of the date you are due to travel.
If you do not declare any pre-existing medical conditions, they will be excluded from your cover. These include conditions which apply to yourself, all travelling companions and anyone upon whose state of health your decision to cancel or curtail your trip would depend.
However, any person to be insured on this policy will automatically be accepted for cover, provided they do not have more than one of the conditions listed on the following pre-screening declaration, and have no other pre-existing medical condition/s: