Failure to fully declare medical conditions or symptoms may invalidate the policy without refund of paid premium and we may seek the return of any benefits already paid to you. Please tick if your answer is "Yes".
We take the protection of your personal data seriously. We describe below how we collect, use and protect it.
We will need to collect, use, process, and/or disclose your personal data or personal information about you to process, administer, and/or manage your relationship, account and Policy with us. Such personal data includes (i) information set out in this form and any other personal information provided by you or possessed by us; and (ii) your claims.
Such personal data will be collected, used, processed, and/or disclosed by us for the purposes of:
(collectively the “Purposes”).
We may collect personal data from sources other than yourself, personal data about you, for one or more of the above Purposes, and thereafter using, processing, and/or disclosing such personal data for one or more of the above Purposes.
Your personal data may be disclosed by us to the participating Insurers, Claim Administrators, Assistance Companies, third-party service providers or vendors, and to our professional advisors, wherever they are sited, for one or more of the above Purposes, as such parties, if engaged by us, would be processing your personal data for us for one or more of the above Purposes.
We may share, if necessary, your medical information with your any doctor, clinic or hospital to ensure appropriate care is provided to you and to ensure any claims from you can be properly assessed for benefits. We may also share your information with your Intermediary, if you have requested and authorized us to do so.
You have the right to request a copy of any information we hold on you, and to seek correction of any incorrect information held. Where possible, we will correct the information held in our files or on our systems as quickly as possible from such a request being made.
By signing this form, you confirm you have read, understood, agreed to the above provisions, and consented to SAFE MERIDIAN:
Please read the following declarations carefully and only sign if you understand and accept them.
Please choose "SEND REQUEST" below, and your application will be processed immediately.