Are you Self Employed?

Are you a UK residient & do you reside permanently in the UK

undertake more than 20 air flights per annum or fly other than a fare paying passenger

Ride motorcycles or motor scooters?

engage in Football, Rugby, Equestrian or Winter Sports, or any other sport(s), pastime(s) or activity(ies) likely to involve extra risk of an accident?

Are there any other additional facts affecting the proposed insurance which should be disclosed to Underwriters?

any physical defect or infirmity, or any defect of your sight or hearing or other senses or faculties?

clinical depression, anxiety, or any nervous or mental condition, fainting episode, blackout, fit or paralysis of any kind?

high blood pressure, a heart condition, haemorrhoids, varicose veins or any other circulatory disorder or diabetes?

a 'slipped disc', lower back strain or other spinal disorder, a hernia or any rheumatic or arthritic condition?

asthma, bronchitis or any other respiratory disorder?

any other condition or injury needing medical advice or treatment in the past three years, or that may require future treatment?

Are you currently taking any medication or do you have any medication prescribed?

Have any of your close relatives suffered heart disease, stroke, cancer, kidney disease, or other serious condition or disease?

Have you had any outpatient appointments or seen any Doctor in the last 12 months for any condition you have not already described?

Have you had any claims within the last 3 years, or incident which would have related in a claim?