Please note that you are providing the below declaration to EFU Life Assurance
I hereby declare that I am at present in good health and entirely free from any mental or physical impairments, injuries, disabilities or deformities. I further declare that I am not suffering from any medical condition(s) for which medical advice, diagnosis or treatment has been sought or received or was known or reasonably should have been known to me to exist prior to this date.
I do hereby authorize any physician, nurse or hospital employee to disclose to EFU Life any and all information regarding my medical history. Furthermore, I have reviewed and understood the product details shared online & consent to the fact that no changes will be accepted once the application is submitted.
I further declare that the statements made herein are accurate, true and complete to the best of my knowledge and belief. If anything, contrary to the truth be stated or if any information, which ought to be made herein be withheld or concealed, any policy which may be issued in pursuance of this proposal shall be null and void and the money paid shall be forfeited to EFU Life.
I hereby declare that I am at present in good health and entirely free from any mental or physical impairments, injuries, disabilities or deformities. I further declare that I am not suffering from any medical condition(s) or have any symptoms of COVID-19, for which medical advice, diagnosis or treatment has been sought or received or was known or reasonably should have known to me to exist prior to this date, whether or not medical advice, diagnosis or treatment was sought or received.
I do hereby authorize any Physician, nurse or hospital employee to disclose to EFU Life any and all information regarding my medical history. I have reviewed and understood product details shared online & understand that no changes will be accepted once the application is submitted.
I further declare that the information given and statements made herein are accurate, complete and true to the best of my knowledge and belief. I further agree that these declarations and the statements made herein shall be the basis of the contract between myself and EFU LIFE and if anything, contrary to the truth be stated or if any information, which ought to be made herein be withheld or concealed, any policy which may be issued in pursuance of this proposal shall be null and void and the money paid shall be forfeited to EFU Life.
I hereby declare that me and my family (spouse & children) at present are in good health and entirely free from any mental or physical impairments, injuries, disabilities or deformities. I further declare that none of us is suffering from any medical condition(s) or have any symptoms of COVID-19, for which medical advice, diagnosis or treatment has been sought or received or was known or reasonably should have known to us to exist prior to this date, whether or not medical advice, diagnosis or treatment was sought or received.
I do hereby authorize any Physician, nurse or hospital employee to disclose to EFU Life any and all information regarding our medical history. I have reviewed and understood product details shared online & understand that no changes will be accepted once the application is submitted.
I further declare that the information given and statements made herein are accurate, complete and true to the best of my knowledge and belief. I further agree that these declarations and the statements made herein shall be the basis of the contract between myself and EFU LIFE and if anything, contrary to the truth be stated or if any information, which ought to be made herein be withheld or concealed, any policy which may be issued in pursuance of this proposal shall be null and void and the money paid shall be forfeited to EFU Life.
