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

PART 5 – HAZARDOUS PURSUITS QUESTIONNAIREThis questionnaire only applies if you have ticked any of the hazardous pursuits listed in Part 1.Client oneClient two1. What is the name of the activitythat you have ticked in thehazardous pursuits questionon page 8?If ‘Any Extreme sport’, pleasetell us which oneIf you have ticked more than one activity in the hazardous pursuits question on page 8, you will need tocomplete a separate Hazardous Pursuits Questionnaire for each one. Use this page to give details of thefirst activity and then use the Additional Information section (Part 8), or photocopy this page, to give thesame details for the other activity(ies).2. Do you take part in this asa professional?Yes No Yes No3. Are you a member of arecognised club, associationor professional body?YesNoYesNo4. Where is this activity carried out?If ‘Other’, please tell us whereUK onlyOtherEurope onlyUK onlyOtherEurope only5. Do you ever take part in thisactivity alone?YesNoYesNo6. Do you, or are you likely to, takepart in aerobatics, expeditions,record attempts, testing of anyequipment or underwater internalwreck exploration, in connectionwith this hobby or pursuit?YesNoYesNo7. On average, how many timesa year do you do this activity?8. On average, how many hours ayear do you spend on this activity?times a yearhours a yeartimes a yearhours a year9. If this activity is listed opposite,please answer these additionalquestions, as applicable.Motor car andMotorcyclesportType of motor sportMotor car andMotorcyclesportType of motor sportMaximum enginesize usedccMaximum enginesize usedccMountaineeringor RockclimbingMaximum heightyou climb tometresMountaineeringor RockclimbingMaximum heightyou climb tometresSeverity levelyou climb toSeverity levelyou climb toParachuting orSky divingDo you take part in free-fallparachuting, competitions,sky diving or sky surfing?Parachuting orSky divingDo you take part in free-fallparachuting, competitions,sky diving or sky surfing?YesNoYesNoSailingType of sailing – For example,offshore category 1 or 2SailingType of sailing – For example,offshore category 1 or 2Powerboatracing andExtreme sportsFull detailsPowerboatracing andExtreme sportsFull detailsUnderwaterdivingMaximum depthyou dive tometresUnderwaterdivingMaximum depthyou dive tometres10. Did you tick any otheractivity(ies) in thehazardous pursuitsquestion on page 8?YesNoIf ‘Yes’, please give the same details as above, forthe other activity(ies), in Part 8 (Additional Information)before returning to page 8 and continuing withPart 2.YesNoIf ‘Yes’, please give the same details as above, forthe other activity(ies), in Part 8 (Additional Information)before returning to page 8 and continuing withPart 2.Please now return to page 8 and continue with Part 2.Whole of Life Protection Plan – Application Form and Additional Questionnaires Page 15