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The proponent/Life Assured :---------------------------------------QUESTIONNAIRE TO BE COMPLETED BY THE PROPONENTS/POLICY HOLDERS/PERSONAL MEDICAL/ ATTENDANT/MEDICAL EXAMINER REGARDING DEFORMITY (IES) AND/OR IMPAIRMENT(S) 1. (a) What is the cause of deformity? Whether it is: (i) Congenital (ii) Due to an accident or injury, OR (iii) Due to any underlying disease (b) since when the deformity is present 2. If the deformity is due to any underlying disease, please state the following : (i) (ii) (i.

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