Paper Application

We offer different underwriting terms to suit different needs

Applying under Moratorium terms

Moratorium sets out a waiting period for pre-existing medical conditions, excluding them over a period of two years, but then certain conditions may be covered after that. The main advantages of moratorium underwriting are that it is quicker to set-up and  hassle-free as there are no medical forms to complete

Applying under Full Medical Underwriting terms (FMU)

Full Medical Underwriting is the process that we use to assess your medical history to decide the special terms that we are prepared to offer. The advantage of full medical underwriting is that you may be able to get cover for a pre-existing medical condition that would normally be excluded through a moratorium

If there is not sufficient space on the form for all your dependants, please use a second form. Once you have signed the form, please mail it to Allianz Care at the address given on the form.

If you choose to pay by Direct Debit, please complete and submit the appropriate Direct Debit Mandate as outlined below. Please note that quotes remain unchanged if you choose to pay by Direct Debit.

For payment in Euro, please complete the SEPA Direct Debit Mandate.
For payment in Sterling, please complete the GBP Direct Debit Mandate.
For payment in Swiss Franc, please complete the CHF Direct Debit Mandate.
Please save this form and use Adobe Reader (free) to electronically complete it
If you are seeking dental cover and answered 'Yes' to any dental question in the health declaration section of the Application Form, please complete and return this questionnaire.