All persons ordering our travel insurance must comply with the following policy health declaration. If you are unable to comply then please fill in the following medical referral form or if you need guidance with specific problems, either call 01327 262805 during office hours or email assistance@snowcard.co.uk.

This travel insurance policy contains health restrictions. You must be able to make the following declaration for yourself and each insured person.

FOR YOU AND EACH INSURED PERSON

As far as I know, the following apply:

1. Nobody is waiting for an operation, hospital consultation (other than for regular check-ups), or other hospital treatment or investigations.
2. Nobody has received treatment, other than regular medication, in the last 12 months for:
   • any blood disorder;
   • any psychiatric illness;
   • any form of cancer, leukaemia or tumour;
   • dialysis treatment;
   • a transplant; or
   • dementia.
3. Nobody diagnosed as HIV positive has required treatment for HIV or any HIV-related illness.
4. Nobody has any breathing or heart problem which has needed hospital treatment in the last 12 months.
5. Nobody has been seen by a specialist in the last three months (other than for regular check-ups) or been admitted to a hospital overnight.
6. Nobody has been given a terminal prognosis by a registered doctor.
7. I do not know of any reason (medical or otherwise) why the trip is likely to be cancelled or cut short.

If you, or anyone travelling with you, cannot agree with this declaration when you take out the insurance, you must phone Snowcard Insurance on 01327 262805. You must do this when you take out this insurance and they will tell you if we can give you cover. If you cannot contact them when you buy this insurance, you must contact them within 14 days (but before you travel). They will tell you if they need any more information. If there is a change in your medical condition or the medical condition of anyone travelling with you (after you have taken out this insurance but before you travel) and you can no longer agree with the declaration, you must contact Snowcard Insurance on 01327 262805. They will tell you if your cover can continue. If we cannot continue cover, you may claim for the cost of cancelling at that time.

For annual multi-trip cover, you must agree with this declaration each time you book a trip.

For a close relative or business associate, or anyone else who is not an insured person and whose health may affect the trip: If, at the time of taking out this insurance (or booking the trip if this was later), they had a medical condition for which they –

• were receiving treatment at hospital;
• were waiting for a hospital consultation or treatment; or
• had been given a terminal prognosis, or been told that their condition is likely to get worse in the next 12 months;