HEALTH INSURANCE PORTABILITY REQUEST

A request to move a health policy from one insurer to another, with credit for the cover already earned.

TO:
The Underwriting Manager (Portability)
__________
__________

Sir / Madam,

1. MY PRESENT POLICY

2. MY REQUEST

2.2 I ask you to give me credit under the new policy for the cover already earned under my present policy, including the waiting periods already served, to the extent the portability rules allow.

2.4 I understand that you will decide on my request on your own terms, and that you may accept it, decline it or add conditions.

3. EXISTING ILLNESSES

3.2 I have given you, or will give you on your own form, every fact you ask about, and I have kept back none that you would reasonably want to know.

4. TIMING

4.2 I will not let my present policy lapse until you confirm the new policy in writing.

5. PAPERS ENCLOSED

Yours faithfully,