8/Negative Underwriting Decisions

Insurance companies must provide, if asked, written reasons to their clients for:

• the premiums they charge;
• reducing the insurance cover that is provided;
• refusing an insurance application;
• rejecting a claim; or
• cancelling a policy.

The Chief Medical Officer explains the company's reasoning. We will tell people who want to discuss the health implications of anything that is revealed during the insurance process to contact you, their GP. You will not have to explain actuarial or underwriting decisions.

Is there any information in your report that our Chief Medical Officer should not release to the patient, because this would cause serious physical or mental harm to the patient or another person? Yes/No

If 'Yes', please give details.

Additional Information

I confirm that I have checked this report and updated any information as required from the manual records and that, to the best of my knowledge and belief, the information contained in the report is complete and up-to-date.

Signed_____________________________________________

Name______________________________________________

Qualifications________________________________________

Date_______________________________________________

Payment Details

Cheque payable to ___________________________________

Account Name_______________________________________

Account Number______________________________________

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