Income Protection Application – Step 2

• Which question(s) does the information relate to?
• What medical condition have you been diagnosed with?
• What symptoms have you suffered with?
• When did you first suffer symptoms?
• When did you last suffer symptoms?
• Have your symptoms been continuous?
• Are you receiving any treatment; if yes what treatment?
• Have you had any time off work?
• If yes, how much time off work?
• Are you fully recovered?

In order to process your application Metfriendly will refer to Credit Reference Agencies to confirm your identify. This search will leave a ‘footprint’ on your credit file, which is required to record that the check has taken place. This footprint is not the same as a credit check footprint and has no negative impact on your file. Please read the following:

I understand that you will undertake a search with a Credit Reference Agency for the purposes of verifying my identity. To do so the Credit Reference Agency may check the details I supply against any particulars on any database (public or otherwise) to which they have access. They may also use my details in the future to assist other companies for verification purposes. A record of the search will be retained. Your information may be disclosed to a credit reference agency, which may keep a record of that information; and (b) the credit reference agency may disclose that information, and the fact that a search was made, to its other customers for the purposes of assessing the risk of giving credit and occasionally to prevent fraud, money laundering and to trace debtors.

Please note, when making the declaration below, all relevant facts should be disclosed, even if you are unsure whether they are material to this insurance. Failure to do this may result in the insurance cover being ineffective, even if the proposal has been accepted by the insurer. Do not assume that we will obtain a report from your Doctor. We rely on you to disclose all relevant information. A copy of the terms and conditions of the proposed insurance contract and also a copy of the completed proposal form is available on request.

Declaration

Please read this carefully: I declare that the foregoing statements are to the best of my knowledge and belief true and complete. I agree to abide by the Rules of the Society. I authorise the deduction from my salary of all contributions that may become due. I authorise extra premiums (where required) from my first deduction to ensure my policy starts on my preferred start date. The liability of the society does not begin until the application has been accepted. Any medical condition that arises prior to the startdate must be notified to the Society or your claim may be denied.