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You are being asked to complete this form as part of your membership in a Group Protection policy

You are being asked to complete this form as part of your membership in a Group Protection policy 2026

You are being asked to complete this form as part of your membership in a Group Protection policy Preview on Page 1

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The document is a Medical Declaration form for members of a Group Protection policy with Aviva. It requires personal and medical information to assess eligibility and benefits under the insurance scheme. The form emphasizes the importance of truthful and accurate responses, as inaccuracies may lead to claims being denied or coverage being restricted. It includes sections on personal details, hazardous activities, medical history, family health history, data protection, and consent for medical information access. The document also outlines the rights of individuals regarding their personal data.

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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. Ensure all details are accurate.
Provide your address and company/employer name along with your current occupation and weekly working hours. If applicable, include your annual business mileage.
Complete the Hazardous Pursuits section by indicating if you participate in any extreme activities. Answer truthfully as this may affect your coverage.
In the Medical & Health Questions section, provide details about your height, weight, alcohol consumption, and any tobacco use. Be thorough in answering questions regarding past medical conditions.
Review the Family History section carefully and provide information about any relevant health issues among close relatives.
Finally, read through the Data Protection - Privacy Notice and sign the Declaration section confirming that all information is accurate before submitting the form.

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