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For adviser use only. Not approved for use with ... - Aviva

For adviser use only. Not approved for use with ... - Aviva 2026

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The document is a Medical Declaration form for members of a Group Life and Group Income Protection policy with Aviva. It requires personal and health information to assess eligibility and terms of coverage. The form emphasizes the importance of truthful responses, outlines potential consequences for inaccuracies, and includes sections on personal details, medical history, lifestyle habits, family medical history, data protection, and consent for medical information access. It also explains how personal data will be used and shared in compliance with privacy regulations.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out your Personal Information. Enter your title, forename(s), surname, gender, date of birth, National Insurance number, email, and phone numbers in the designated fields.
Provide your address and postcode accurately. Include details about your company/employer and current occupation along with hours worked per week.
If applicable, indicate if you plan to travel outside Europe or North America for business by selecting 'Yes' or 'No', and complete the additional section if you answered 'Yes'.
Proceed to the Hazardous Pursuits section. Answer whether you participate in any listed activities by selecting 'Yes' or 'No'.
Continue through the Medical & Health Questions section, providing accurate information regarding height, weight, alcohol consumption, smoking habits, and any medical conditions.
Complete the Family History section by indicating any relevant conditions affecting family members before age 60.
Review all sections carefully before signing the Declaration at the end of the form to confirm that all information is truthful and complete.

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