Allianz Canadian Expatriates/ Inpatriates to Canada
Medical Questionnaire Detailed
How to complete this form
• Complete one form for each person applying for insurance.
• Answer all questions on the form.
• If you’re unsure about your answers, please talk to your physician first.
• Applicant, legal guardian or power of attorney must sign and date the form.
• If you have any questions about this form, you can reach us toll-free at: 1-888-298-8151.
• If your application is missing information or isn’t signed and dated, we’ll have to follow up with you or your agent/broker and it will take longer to process your application. For the complete terms, conditions, limitations and exclusions please refer to the policy.
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