Preliminary Underwriting Medical Enquiry Form

For your convenience this Preliminary Underwriting Medical Enquiry Form has been designed to quickly check if a proposed member is eligible for cover based on any serious pre-existing medical conditions.

Please download the form below and ask your client to complete it (including signature). Once completed send the Preliminary Underwriting Medical Enquiry Form, along with any supporting documentation to the email address provided. The Allianz Worldwide Care Underwriting Department will respond to you, the broker, within 24 hours.

Preliminary Underwriting Medical Enquiry Form (Editable WORD version)

Preliminary Underwriting Medical Enquiry Form (PDF version)