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Zurich forms and guides

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New business forms

Underwriting forms

Underwriting Forms

 MSP13138 Arthritis questionnaire (530.68 KB/PDF)

- Arthritis, osteoarthritis, rheumatoid arthritis or gout

 MSP13140 Back disorder questionnaire (518.43 KB/PDF)

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

 MSP13141 Business, keyman and loan covers questionnaire (614.97 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 (529.86 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

 MSP13774 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 (80.33 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 (539.38 KB/PDF)

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

 MSP13136 Sailing questionnaire (554.66 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

 MSP13857 Substance use questionnaire (571 KB/PDF)

-To be filled by the life insured when requested by Zurich.

 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

 MSP13125 Tobacco or nicotine use change (277.28 KB/PDF)

- to update your policy when you stop smoking or using nicotine.