Please note all beneficiaries on one membership to be under same scheme as applicant
Please complete the questions below as accurately as possible. It is important to disclose all pre-existing conditions. Failure to disclose material information or provision of incorrect information may result in immediate suspension or cancellation of membership or benefits. The questions below applies to the Principal member all the beneficiaries covered under this membership application. Have any of the applicants suffered from any of the following conditions.
Any other condition not stated above. If yes please give detail in the table below.
If you have ticked YES for any of the above, please complete the section below. Please disclose all the important information.
I declare that any false information in the above questionnaire or the non disclosure of any material information will render the membership null and void.