€100,000 Life Cover per member @ €10.00 per month (€120.00 per annum)
€10,000 Life Cover per child aged 1 up to 21 automatically Included.
This premium will be reviewed in January 2019
When answering the questions in this section you must give full and accurate information in relation to all Material Facts.
Material Facts: I understand that I must disclose all Material Facts. A Material Fact is any fact that may influence the assessment and acceptance of an application for insurance or may increase
the possibility that you will make a claim under this policy. If you are in any doubt about whether a fact is material, you should disclose full details.
However, it is important that you are aware that in accordance with the provisions of part four of the Disability Act 2005 you
should NOT disclose the result of any genetic (DNA or RNA) test.
You must disclose if you are having treatment for, experiencing symptoms of, or having investigations (other than a genetic test) for a genetic condition as well as disclosing all other conditions. You must also give us full information about your family history (without disclosing the name of any relatives), including all genetic conditions.
Please check the details you have provided are correct.If you need to make a change please use the form's previous and next buttons to navigate to the page you wish to amend.
Please read the following policy, data sharing, and permission to request further information declarations before submitting.
Zurich Life Assurance plc ('Zurich Life') is a member of Zurich Insurance Group ('the Group'). In order to provide a seamless insurance service globally, Zurich Life may transfer any data it has received from, and any data it holds on me to other units of the Group, such as branches, subsidiaries, or affiliates within the Group, cooperative partners of the Group, coinsurance and reinsurance companies located in this country or abroad.
Zurich Life, as well as such recipients may use, process and store the data, in particular for the purpose of risk evaluation, policy execution, premium setting, premium collection, claims assessment, claims processing, claims payment, statistical evaluation or to otherwise ensure the Group global insurance service delivery.
If a financial advisor or agent is acting on my behalf, Zurich Life is authorised to use, process and store data received from such financial advisor or agent, and to forward to such financial advisor or agent my data relating to the execution of the policy, collection of premiums and payment of claims.
Zurich Life may procure data from third parties to assess a claim. Zurich Life may check my personal data against international/economic or financial sanctions, laws or regulated listings.
You have a right of access to and the right to rectify the data concerning you held by Zurich Life/the Group.
Zurich Life may, in future, want to use your data to tell you about its products and services, those of the Group or of a third party that they have arranged for you. If you do not want your data to be used for these purposes, please tick here.
You can ask Zurich Life at any time to stop using your data in this way, by writing free of charge to Customer Services, Zurich Life Assurance plc, Zurich House, Frascati Road, FREEPOST, Blackrock, Co. Dublin.
I agree to give Zurich Life permission to request medical information from any doctor that I have attended and to request relevant information from any other insurance office that I have applied to for life insurance cover. I agree that this authority will remain in force after my death.
I confirm that I have read, fully understand and agree to all parts of the above declarations ((i), (ii), (iii), and (iv)), the commitment to provide honest and complete information on page one and that, as a policy owner I will be the beneficial owner(s) of this policy.
I am aware that if I do not answer all of the questions honestly and completely, Zurich life may decline to play a future claim.
Zurich Life may, in the future want to use your data to tell you about its products and services, those of the Group or of a third party that they have arranged for you.