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Application for Policy Change (Underwriting Required) Quick Reference

Application for Policy Change (Underwriting Required) Quick Reference 2026

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The document is an application form for non-smoker life insurance rates, outlining the eligibility criteria, duty of disclosure, and privacy considerations. It requires the life insured to confirm they have not smoked in the past 12 months and provides details on the consequences of failing to disclose relevant information. The form also includes sections for personal details, smoking history, and declarations from both the life insured and policy owners.

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Click ‘Get Form’ to open the Application for Policy Change in our editor.
Begin by filling in your policy number and type at the top of the form. Ensure you select from options like Wealth Protection, Sumo, or FutureWise.
In the 'Life Insured Details' section, enter your title, surname, given names, date of birth, address, and contact details using BLOCK LETTERS for clarity.
Complete the 'Smoking History' section by selecting applicable options regarding your smoking status. If option (b) is selected, provide detailed information about any medical conditions related to smoking.
In the 'Declaration' section, confirm that you have not smoked in the last 12 months and acknowledge your duty of disclosure. Sign and date where indicated.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (96 Votes)
2018	4.2 Satisfied (100 Votes)
2017	4.3 Satisfied (58 Votes)

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Application for Policy Change (Underwriting Required) Quick Reference 2026

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Application for Policy Change (Underwriting Required) Quick Reference 2026

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