Declarations: I acknowledge that all pre-existing conditions as defined in the exclusions are not covered. I confirm that the details made in this application describe the basis of the contract between the policyholder and the insurer. The General Terms and Conditions will be sent to me together with the Policy Documentation. I accept these General Terms and Conditions to be part of the contract of insurance issued as a result of this Application.

I authorise the release of any medical information to the Insurer or to the Claims Service acting on behalf of the Insurer as is required to settle all eligible benefits to me, my spouse or children for this claim. A copy of this authorisation shall be considered as effective and valid as the original.