WINNER OF THE HEALTH INSURANCE AWARDS 2009, 2011 & 2015

This will give us all the initial information we need to research the market for you.  A copy of this will be emailed to you for verification and your data is kept completely confidential.  We ask that you complete all the details below so that we can find you the best possible deal available.  Proactive Medical & Life are award winning specialists in the corporate and personal healthcare market.

*Failure to disclose certain information may invalidate your insurance, therefore could mean that your insurance will be cancelled or a claim will not be met.  Please see our Terms and Conditions 

Personal Fact Find for UK health insurance plans

Are you a UK Resident?



If NO have you been in the UK for more than 3 years?



Are you registered with an NHS GP?



Personal Medical History

If you are uncertain of anything please disclose this information in any case, as we will need this to verify your personal situation:

In the last five years have you?





Have you ever suffered from the following:







APPLICANT 2 or Partner

Are you a UK Resident



If NO have you been in the UK for more than 3 years?



Are you registered with an NHS GP



PERSONAL MEDICAL HISTORY

if you are uncertain of anything please disclose this information in any case, as we will need this to verify your personal situation:

In the last five years have you?





Have you ever suffered from the following:







DEPENDENTS

In the last 12 months have you been referred to a specialist or had treatment other than a GP visit?



What type of cover am looking for?










What other personal protection are you considering?





DECLARATION

The information requested by us is required to ensure that any product offered is appropriate to your personal circumstances. Failure to provide some information may lead to inappropriate advice/information being given. The information may be held on file and may help form the basis of future services.

*Our definition of smoker is someone who smokes or has, within the last 3 years, smoked cigarettes, cigars, tobacco or a pipe. 

This information is provided on the understanding that it will be used in strict confidence and that it places you under no obligation to take any suggested recommendations.

Periodically we issue information and newsletters to clients to keep them abreast of tax and product changes. 

DISCLAIMER

We are registered under the Data Protection Act 1998 with the Information Commissioners Office.

Information provided by you may be held, processed, disclosed and used by ourselves, professional advisers and any associated companies in servicing our relationship with you. However, strict confidentiality will be maintained at all times.

It is understood that, unless you notify us otherwise, you agree to the storage, use and disclosure of such information. This information may be disclosed to third party insurers or companies in connection with in the course of providing our analysis and servicing of our relationship with you. You also agree that for the purposes described above your data may be transferred to countries outside the European Economic Area.

We may use and analyse your data, including the nature of your transactions, to provide you with information by post, telephone, fax or e-mail to service and update you, as well as informing you of new investment opportunities and contacting you in connection with your health insurance requirments. If you would prefer to be excluded from these services, please write to us at the company address on the contact page of this website.

     

Proactive Medical & Life Ltd Registration Number: 06483379 is an Appointed Representative of Healthnet Services Limited, who are authorised and regulated by the Financial Conduct Authority. Healthnet Services Limited entered on the FCA register No 312313