Get Health Statement Form Axa

The Health Statement Form Axa is an important document that needs to be accurately completed by the policy owner or assignee. This guide will provide you with a step-by-step approach to effectively fill out the form online.

Follow the steps to successfully complete the Health Statement Form Axa online.

1. To begin, click the ‘Get Form’ button to obtain the Health Statement Form Axa and open it for editing.
2. Fill in your policy number, which is PPH1HTHSTF, in the designated section at the top of the form.
3. Carefully read the important notes. Ensure that you fill in the form using BLOCK LETTERS and avoid signing on a blank form.
4. In the section for type of request, select the appropriate option by shading the circle corresponding to your choice.
5. Provide your full name as the insured, along with the last name, first name, and middle initial in the specified fields.
6. Fill in the full name of the policy owner and the assignee, ensuring accuracy for all provided names.
7. Answer the health and avocation questions by selecting 'Yes' or 'No' where applicable. If you answer 'Yes,' provide the required details in the given spaces.
8. Input your height and weight for both the insured and the policy owner in the appropriate sections of the form.
9. Sign the form where indicated, confirming that the information provided is true and complete. Include the date and place where you are signing.
10. Finally, review your completed form for accuracy. You can then save your changes, download a copy, print it, or share it as necessary.

Complete the Health Statement Form Axa online today to ensure your policy details are up to date and accurately represented.