1. You have not been refused Travel Insurance
by any other company nor are you insuring with the intention of receiving
medical treatment or to claim for events which have already occurred.
2. You are not aware of any circumstances likely
to lead to cancellation or curtailment of the trip. The underwriter is
aware of all facts likely to affect the acceptance or conditions of this
insurance. You will notify the underwriter of changes in circumstances
or health occurring prior to your commencement date.
3. You confirm details have been correctly
declared in this application form including the Medical Certificate incorporated
in this document to be submitted for approval by the underwriter.
4. You agree, in the event of illness or injury
giving rise to claims under the medical section of the policy, to be medically
evacuated to Australia, New Zealand or your Country of Origin, as applicable,
at the underwriters discretion.
5. You agree to a waiver of privacy in that
you consent to any requested medical information being released by your
doctor, specialist, or other health provider to the Underwriter or its
agent and to the release of any further information necessary for the purposes
of this insurance.
6. You authorise any claim to be paid to any
named institution which has submitted claim details and requested payment
to be made to them on your behalf.
7. You accept that failure to supply correct
application and medical certificate details may affect the validity of
the policy.
8. You have certain rights of access to and
correction of this information.
9. You understand that this policy does not
cover any event, which happens to you unless you, at the date of such event,
are aged 65 years or under.
10. You understand and agree that the act of
transmitting this application to Uni-Care, by activating the 'Submit Application'
button on the web application form, will have the legal force of a signature.
11. You have read and understood and accepted
the above statements and accept responsibility for all the information
provided in this application.
Declaration Box - The Declaration
Box must be clicked in order for your application to be submitted.
APPLICANT STATEMENT: I have clicked in the Declaration Box as proof
of the fact that I have read, agree and accept paragraphs 1 to 11 of the
Declaration which is a compulsory element of the Uni-Care on-line application
form.
Click on this button only once. There may be several seconds delay
before an acknowledgement appears. If you click twice we receive two application
transmissions. We remind you that a correct working email address
is essential for our confirmation.