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Zurich forms and guides

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Underwriting forms

Underwriting Forms

 MSP13138 Arthritis questionnaire (587.07 KB/PDF)

- Arthritis, osteoarthritis, rheumatoid arthritis or gout

 MSP13140 Back disorder questionnaire (573.89 KB/PDF)

- Spinal (back or neck) disorders, muscular or joint disorders

 MSP13141 Business covers (135.43 KB/PDF)

- Keyman, partnership and loan cover

 MSP11602 Declaration of insurability (496.96 KB/PDF)

- To confirm information disclosed in the health and lifestyle questionnaire has not changed since initial application; including medical, occupation, travel, hobbies, etc.

 MSP13130 Diabetes questionnaire (574.04 KB/PDF)

- Diabetes or impaired fasting glucose

 MSP12647 Digestive system questionnaire (574.07 KB/PDF)

- Digestive disorders, Crohn’s Disease, ulcerative colitis, gastric reflux, ulcers or hernia

 MSP11596 Diving questionnaire (517.61 KB/PDF)

- Diving for professional or recreational purposes

 MSP11611 Epilepsy questionnaire (167.71 KB/PDF)

- Epilepsy, fits, multiple sclerosis or other neurological complaints

 MSP11608 Financial questionnaire (131.37 KB/PDF)

- For financial underwriting to assess the life insured’s eligibility for the level of cover requested

 MSP13144 Genito-urinary disorder questionnaire (556.48 KB/PDF)

- Urinary or kidney disorders, stones, pyelonephritis, blood or protein in urine

 MSP11609 Growths, cysts, tumours & lumps questionnaire (509.72 KB/PDF)

- Growths, lumps, tumours, cysts, abnormal moles or skin lesions

 MSP12676 Health and lifestyle questionnaire (69.1 KB/PDF)

- Health, lifestyle, work, family history, medical history, country of residence

 MSP11610 Hypertension questionnaire (512.56 KB/PDF)

- High blood pressure

 MSP12648 Mental health questionnaire (546.15 KB/PDF)

- Mental health issues such as depression, anxiety, schizophrenia, eating disorders, or bipolar disorder

 MSP11597 Motorsport questionnaire (518.31 KB/PDF)

- Amateur and professional motorsports

 MSP11594 Mountaineering questionnaire (538.24 KB/PDF)

- Indoor and outdoor climbing

 MSP11605 Occupational questionnaire (535.58 KB/PDF)

- Lifting or moving heavy goods; working underground, at heights, or with specialised equipment; handling dangerous materials such as explosives, chemicals, radioactive matter; or subjection to adverse environmental conditions

 MSP11606 Oil and natural gas questionnaire (526.75 KB/PDF)

- Working underwater, at heights, in the drilling area or with explosives in the oil and gas industry

 MSP11443 Reinstatement health & lifestyle questionnaire (57.78 KB/PDF)

- To be completed when a plan with insurance benefits has lapsed and there is a request for it to be reinstated

 MSP12646 Respiratory supplementary questionnaire (544.35 KB/PDF)

- Respiratory conditions such as asthma, chronic bronchitis or obstructive airways disease

 MSP13136 Sailing questionnaire (556.57 KB/PDF)

- Amateur and professional sailing (lakes, rivers, sea, trans-ocean, round the world)

 MSP11591 Subject access request form (507.13 KB/PDF)

- For requests by the life insured for medical records to be sent to a medical practitioner

 MSP10776 Travel questionnaire (516.42 KB/PDF)

- If the life insured has visited or intend to visit Iran, Iraq, Yemen, Afghanistan, Pakistan, Syria, any country of the former Soviet Union or any country in Africa