Whole of Life Application Form (W10243) - Legal & General

FAMILY HISTORY continuedClient oneClient twoIf you don’t know the details ofthe medical history of your parents,brothers and sisters please tellus why.Don’t know – AdoptedNo further contact with family membersDon’t know – OtherIf ‘Other’, please give detailsDon’t know – AdoptedNo further contact with family membersDon’t know – OtherIf ‘Other’, please give detailsPART 3 – ABOUT YOUR POLICYIs this policy that you’re applying forreplacing any existing policies heldwith Legal & General?We may need to get authority tocancel the policy if it is in trust orowned by someone else.YesNoIf ‘Yes’, what is the policy number(s) of your existingLegal & General policy(ies) that will be replaced?YesNoIf ‘Yes’, what is the policy number(s) of your existingLegal & General policy(ies) that will be replaced?Is this policy that you’re applyingfor to be issued under Trust?YesNoIf ‘Yes’, which policy(ies)?YesNoIf ‘Yes’, which policy(ies)?If you have answered ‘Yes’ to the above question, please contact your Financial Adviser about the type of trust most appropriate to you andyour circumstances.Is this policy that you’re applyingfor to be owned by anotherindividual or company?YesNoIf ‘Yes’, which policy(ies)?YesNoIf ‘Yes’, which policy(ies)?If you have answered ‘Yes’ to the above question, please fill out your doctor’s details below, then complete a Policy Owner Questionnairefor each policy (Part 7) BEFORE going straight to Part 9.Doctor’s detailsPlease include your doctor’spractice name or clinic, postcodeand telephone number as thisis essential for processing yourapplication more quickly.Doctor’s namePractice/clinic name and address(including postcode)Doctor’s namePractice/clinic name and address(including postcode)AsClient 1Please don’t assume that wewill contact your doctor forconfirmation of medical details.PostcodePostcodeTelephone numberTelephone numberThis now completes the mandatory question and answer part of your application.The following green sections are all additional questionnaires which you only need to complete if we’ve asked you to in one of theprevious questions, or if you need to provide us with additional information. Please now ensure you read and sign the Client Declarationand Consent in Part 9 and complete the Direct Debit instruction in Part 10.Page 12Whole of Life Protection Plan – Application Form and Additional Questionnaires