I declare that the information I provide in this application is complete, true and correct to the best of my knowledge and I will provide all medical and health information which might affect Cigna’s ability to offer me (or any other proposed Insured Person) cover.

I understand that the information provided now or in the future in completing this application will form the basis of my proposed contract with Cigna, and failure to disclose any material facts or information or which Cigna would regard as likely to influence the assessment and acceptance of this application may render voidable by Cigna the insurance coverage that may be issued pursuant to this application.

I agree that acceptance of any policy issued based on this application will constitute an agreement to its Terms and Benefits. I understand that the insurance under such policy will become effective only when the policy is delivered and the first premium is paid, provided there has been no deterioration in the Insured Person’s insurability before such delivery and payment is made.

I understand and agree that additional information and/or evidence in relation to the identification and verification of my identity and that of any other proposed Insured Person may be requested by the Cigna as deemed necessary.

I hereby authorise, and confirm that all other proposed lnsured Person(s) have authorised, any licensed physician, medical practitioner, hospital, clinic or other medical or medically related facility, insurance company or other organisation, institution or person, that has any records or knowledge of my/our health to give to Cigna and its reinsurers any such information for the purpose of assessment of this insurance application and/or claims under any policy issued based on this application.

I understand the provision of above information means I agree to Cigna's use and/or transfer of my personal data for direct marketing of its related insurance products and services. I have read and accepted the Personal Information Collection Statement of Cigna. I understand that I have the right to opt out of the use of my/our personal information in accordance with the options set out in the Statement. I understand that opting out will mean that Cigna or any third party provider of the specified classes of products and services will not be able to send me/us any direct marketing, targeted or special offers in the future.