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AXA Medicare International Health Insurance – Medical Declaration

Dear Valued Customer,

Thank you for moving forward with AXA Medicare International Health Insurance.

As part of AXA’s review process for your application, kindly complete the following medical health questionnaire. The form is brief and should only require a short time to complete.

Please note the following important information:

1. A separate form must be completed for each individual covered under the policy, including yourself and any additional family members.

All questions relate only to the period before the policy commencement date. The questionnaire applies solely to your medical history prior to the start of coverage.

2. Any undeclared medical condition related to the questions may affect future claim assessments. In cases of inaccurate information, non-disclosure, or dishonesty, AXA reserves the right to decline claims or cancel the policy.

3. Please ensure all answers are completed accurately and completely. If you answer “Yes” to any of the questions, our team will contact you regarding the next steps.

Thank you very much for your cooperation.