I have never suffered from any form of disease, high blood pressure, high cholesterol, circulatory disease, lung disease including asthma, neurological diseases, ulcer, cancer, tumor, stroke or cyst whether benign or malignant, diabetes, mental or nervous disorders, liver disease including hepatitis, HIV infection or AIDS, ear or eye disease.

I have never suffered from any other chronic or long term medical condition not mentioned in point 1 above

 I have not taken any kind of medication for more than 10 consecutive days during the last 2 years to treat any illness or disease.

 I have never been absent from work or taken leave on health grounds for more than 10 days during last 12 months.

During the last 5 years, I have never consulted any medical practitioner for any medical condition other than minor illness (such as cold or flu) or have never been hospitalised or had no surgical operation.

My application for life, disability or health insurance /takaful has never been declined, postponed or accepted with special terms /extra contribution or restrictions.

I do not smoke /consume alcohol

 I do not have any physical or mental impairment am I am in good health

 Applicable for females only – I am not pregnant at present and I do not have any history of gynaecological problems.​