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PDF Cyst Mole Skin Lesion Questionnaire - Zurich Australia

PDF Cyst Mole Skin Lesion Questionnaire - Zurich Australia 2025

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4.8 out of 5

83 votes

The document is a Cyst/Mole/Skin Lesion Questionnaire required by Zurich Underwriting for life insurance applicants. It outlines the necessary information to be provided by the life insured regarding any cysts, moles, or skin lesions, including details about diagnosis, treatment, and follow-up care. The document emphasizes the importance of truthfulness in responses to avoid misrepresentation and explains privacy considerations under the Privacy Act 1988. It also includes a declaration section for the life insured to confirm the accuracy of their information.

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Click ‘Get Form’ to open the PDF Cyst Mole Skin Lesion Questionnaire in our editor.
Begin by filling in your personal details in the 'Life insured details' section. Use BLOCK LETTERS for clarity, including your title, surname, given names, date of birth, and contact information.
Proceed to the 'Cyst/mole/skin lesion details' section. Answer questions (a) through (f) regarding the type, location, diagnosis date, removal status, and pathology results of your cyst/mole/skin lesion.
In the continuation of the 'Cyst/mole/skin lesion details', provide any further treatment or follow-up information if applicable. Fill in your doctor's details as required.
Complete the 'Declaration' section by confirming that all provided information is true and accurate. Sign and date the form at the bottom.
Once completed, save your document and either print it or send it via email as a scanned attachment to Zurich Australia.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (83 Votes)
2017	4.3 Satisfied (38 Votes)

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