For insurance purposes including underwriting or administering an insurance contract and to assess the terms of your insurance contract, when we deal with changes to your policy and/or deal with claims that arise, Aviva and its agents need to collect and use information about health relating to you and (where relevant) family members. This includes questions regarding mental health conditions, where these are relevant to the products being applied for. Please see our Privacy Notice for more details. Please remember that we ll use the answers you give to assess the terms and benefits we can offer you. Even if you ve already provided information in a previous application, you must provide it to us again.

Your lifestyle

What is your height?

What is your Weight?

In a regular week, do you consume more than 10 alcoholic drinks per week? (1 drink is equal to a pint, glass of wine or double measure of spirit)

Have you ever asked for or received advice to reduce your alcohol consumption?

In the last 10 years have you used: Recreational drugs? Any stimulants, sedatives, tranquilisers or anabolic steroids not prescribed by a doctor? Methadone? Your answer is confidential and we ll only use it to assess your application and in the event of a claim

You do not need to tell us about any predictive genetic test results unless this application, together with any existing cover, will total over £500,000 of life insurance. If your cover is over this limit, we only need to know about predictive genetic tests for Huntington s disease. You can tell us about any negative predictive genetic test results, because it may help your application.

Have you ever had:

Please tick all that apply. If none apply, tick None of the above

Apart from anything you ve already told us: In the last 5 years, have you had, or been advised to have, an appointment, investigation or referral with a medical specialist other than a GP at your surgery?

A medical specialist is anyone other than a GP at your surgery (This includes hospital, nurse or therapist referrals)

Apart from anything you ve already told us are you currently:

You don t need to tell us about the oral contraceptive pill or a routine smear test unless your last screening showed some abnormality. You can also ignore minor accidents and injuries. For example, a strained, pulled or torn muscle or ligament.

Do you have any plans or intentions to travel to Ukraine, Russia or Belarus; or Israel, the West Bank or Gaza Strip; or any other countries where there are areas of internal conflict or insecurity, or Are you a member of the Armed Forces, the Armed Forces Reserves or Territorial Army? If you are unsure about the security situation in a country you may visit, please open a new browser page and check for travel advice on the Foreign, Commonwealth & Development Office (FCDO) website https://www.gov.uk/foreign-travel-advice site. If the FCDO advises against any travel to any part of the country you should answer the question as Yes