Tances, or used nicotine replacement products in the last 12 consecutive months. Please use BLOCK LETTERS. Policy number/s Policy type: Wealth Protection Active Sumo FutureWise Other Your duty of disclosure Before entering into a life insurance contract, we must be told anything that each of you as the proposed policy owner and the life to be insured (if a different person to the proposed policy owner) knows, or could reasonably be expected to know, may affect ou.
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How to fill out the AU Zurich ZU11821 online
Filling out the AU Zurich ZU11821 form for non-smoker rates is a straightforward process that ensures a proper application for life insurance. This guide will walk you through each section of the form to help you complete it accurately.
Follow the steps to fill out your application for non-smoker rates
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering your policy number(s) in the designated field. Next, select the policy type from the options provided: Wealth Protection, Active, Sumo, FutureWise, or specify another type.
- In the 'Life insured details' section, fill in your title, surname, given names, date of birth, and address using block letters. Also, provide your contact details including work, home, and mobile phone numbers, as well as your email address.
- Proceed to the 'Smoking history' section. Indicate which applicable options (a) or (b) pertain to you regarding your smoking history. If you select option (b), please provide the detailed information requested in the table, including condition, test results, treatment received, and relevant dates.
- In the 'Declaration of the life insured and policy owner' section, ensure that all statements have been read and acknowledged. Sign and date the declaration as the life insured and have the policy owner(s) do the same.
- Once all sections have been filled out, ensure that all information is accurate. You then have the option to save changes, download, print, or share the completed form.
Complete your AU Zurich ZU11821 form online to proceed with your application for non-smoker rates.
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