Cover commences at the date requested by the Policyholder and on the date his/her application form is received by Amariz if it is later, subject to medical acceptance. In the event of further medical investigation being necessary for one or more of the persons listed on the application form, such medical evidence must be forwarded to the Insurer for acceptance. Until the Insurer’s decision to cover the applicable person has been received by the Policyholder, Accident cover only shall be provided for a maximum of two (2) months from the date requested by the Policyholder or from the date of receipt of their application form by the Broker if that is later, in respect of such person. The Insurer reserves the right to ask for any proof of state of health or medical examination.
You must take care in answering all the questions which are relevant to the Insurer in providing this insurance and setting the terms and premium. Please contact the Broker if you do not understand the question or the nature of the information required. Failure to provide information or the provision of incomplete or inaccurate information may result in loss of cover or other remedies.
I understand that any information provided will be processed in compliance with the General Data Protection Regulation (GDPR), for the purpose of providing insurance and handling claims or complaints, if any, which may necessitate sending my personal and medical information to other parties, including a broker situated outside of the EEA for the purpose of negotiating the terms of acceptance of my insurance or the payment of a claim with the Insurer. If further medical investigation is considered necessary in order to process my application form or a claim, personal and medical information I have provided may be given to the Insurer’s Consulting Doctor and I will receive written confirmation of this, including details of who the information has been sent to.
I declare on behalf of all persons to be covered that the information on this application is to the best of my/our knowledge and belief both accurate and complete. I have taken care not to make any misrepresentation in the disclosure of this information and understand that all information provided is relevant to the acceptance and assessment of this insurance, the terms on which it is accepted and the premium charged.
I on behalf of all persons to be covered will tell the Broker on behalf of the Insurer if any of the information on this application form changes during the period of insurance and I understand that if any of the information is not true, or becomes untrue, the persons covered may not have insurance cover or other remedies under the health insurance policy to which this application form relates.
By completing this application, I am applying on behalf of all persons to be covered on this insurance and am doing so with their full consent. I also agree to receive all plan-related documentation on behalf of all persons to be covered.