Pilots Life Cover Plan

Insure First W.L.L  Qatar General Insurance
  1. Complete the following form and then click the print button.
  2. Sign the printed form, scan and send it to info@insurefirst.com.qa, with a copy of your QID card.

Medical Declaration:

To join this insurance plan we do not require any applicants to undergo any form of medical screening. We just need you to complete our simple ‘7’ medical declaration:

Short Declaration:

I declare that:

  1. I am actively at work and/or fully fit for duty and have been for a continuous period of 30 days.
  2. I am the holder of a valid medical certificate which does not have any medical restrictions of any kind placed upon it (other than a standard visual/use of glasses if applicable)
  3. I am not on the advice of any Health Practitioner taking any form of medication or following any special diet or treatment plan.
  4. I have not taken any form of medication for a continuous period of more than 28 days.
  5. I have not been on sick leave for more than 14 consecutive days as a result of accident or sickness during the past 3 years.
  6. All of my routine ECG examinations have been accepted without the need for further referral or specialist examination.
  7. I have never been assessed as long term unfit nor had my license permanently revoked.

IMPORTANT

If there is any change in the information declared after the date you sign this declaration form and before any cover offered by us commences, you must advise Insure First Insurance Brokerage immediately. We may alter the terms quoted to you in such circumstances. If you do not make a true and complete disclosure of material information, we may at our election cancel your policy or modify the terms on which it was issued. It will also prejudice your ability to claim under the policy and we will not refund any premiums paid.


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You are applying for the Insure First Insurance Brokerage ‘Pilots Life Cover Plan’ and details of this Plan have been made available to you.