Declaration-please read carefully and complete
This application form will be the basis for the contract between the Insured and the Insurer. Any employee(s) proportion of the Policy Premium will be paid in full by the Insured, without recovery from the employee(s). All Insured persons meet the eligibility criteria for the scheme.
Entry onto the policy will be with one of the following underwriting methods:
Moratorium It is understood that the policy will not cover any investigation and/or treatment for any illness related medical condition for which the persons to be insured underwent treatment, sought medical advice or were aware of symptoms within the two years before the start date of this policy.