Insurance Underwriting Pre-Assessment

Pre-assessments help you get a better understanding your insurance options if you have a pre-existing medical condition, participate in a hazardous pastime or there is another factor that affects your insurance eligibility.

A pre-assessment will help you determine which insurer from some of the leading life insurers in Australia will offer cover on favourable terms after an initial review of your circumstances. We conduct this on an anonymous basis on your behalf.

After it is completed, you will have a better understanding of what revised terms, such as a loading or exclusion, may be applied to your policy.

Please complete the following basic details to help us investigate if insurance cover is viable for you

Name

We will remove this from Pre-Assessments to keep the assessment anonymous.

First Name

Last Name

Phone

Email Address

State You Live In

NSW / QLD / VIC, etc

Date of Birth

MM/DD/YY

Gender

Male

Female

Smoker Status

Non-Smoker

Smoker

Height (cm)

Weight (kg)

Occupation

Qualifications

Work Duties

i.e. office based, admin, driving, etc. Include % of time allocated to each.

Annual Income

Pastimes

Sports, activities, etc

Have You Been Diagnosed with a Medical Condition?

Do You Regularly Take Any Medication or receiving any treatment at the moment?

Have any of your immediate family members been diagnosed before the age of 60 with: cancer, heart disease (including cardiomyopathy), stroke, polycystic kidney disease, Huntington’s disease, Alzheimer’s or dementia, diabetes, motor neurone disease, multiple sclerosis (MS) or Parkinson’s disease?

Immediate family are Mother, Father, Brother or Sister

Have you ever had any significant injuries?

i.e. knee reconstruction, back injury, etc.

Any other information you feel is relevant

Privacy and Electronic Consent

We respect your privacy and are committed to ensure that any Personal Information we collect about you is handled in accordance with the provisions of the Privacy Act 1988 and the Australian Privacy Principles and any other applicable privacy related laws. Please refer to the footer of the page for a link to our Privacy Policy. We will be providing your Personal Information to insurers for the purposes of obtaining pre-approval for personal insurance purposes only.

I/We declare that we give consent for our personal information to be held on file and where indicated communication/documents to be provided electronically.

Insurance Underwriting Pre-Assessment

TruePenny Advisers