All conditions, symptoms and or disorders have to be declared, no matter how insignificant they may seem.
Incomplete, inaccurate information or information that is withheld may result in the termination of your membership effective from date of registration.
If you answer Yes to any of the questions please provide full details. If you do not have any conditions to declare, please move to the next section.
More than one (1) condition may be applicable to a question, if so, you need to reselect the question in order to complete additional information.
Failure to disclose or register dependants living with HIV with Lifesense (0860 50 60 80) within 21 days will be considered as non-disclosure and may result in termination of your membership.