I/We agree that the proposal will form the contract between me/us and the Company.
I/We agree to accept this policy with the exclusion of any claim which results from any pre-existing chronic illness which has resulted in referral to a consultant or hospitalisation of the Insured Person(s) during the 24 month period prior to the Policy being taken out, to all relevant sections of the policy. I/We agree that the statements made by me/us or on my/our behalf are true and complete and will advise the Company of and material change relating to the health of the person(s) to be insured.