Fe /Ou have undergone a surgeny please provide discharge summary i within 5 year period f planning to, please specty condition and surgery type NAc 7 Have you ever been treated or currently clagnosed with Cancer/Lump/Cyst/Tumor? Yes] Not] [1988, please attach medical supporting documents or @ medical report indicating diagnosis, Current neatth status & previous - present treatment plans. 8. Ne you curently infected or got infected from any communicable or respiratory diseases Yes] Nol] (eg. COViD-19..)? yes, please specity date it started & how long didit let wa 9. Are you currently having or had any signs, symptoms, sickness or medical complication’ Yes) No[] during the past 2 years? lye kindly provide detals inthe Remaks/Adctonel ntomation box 10. Has ery of your application fre, accident, crcl ness or heath insurance been Yes] NoC] declined, postponed or accepted on special terms? Ityes, kindly provide details in the Remarks/Adcitional Information box. | declare that | have clearly understood the terms and conditions of the product ! am applying for and have clearly Tee eloed i features and benefits inclucing the excisions. futher declare that Ihave ares) a fe ‘questions in (rated OF void. | hereby authorize Oman insurance Company i) to contact me aryiime andl through any megium (Phone, emai, “sms, telephone etc) for purpose of obtaining more information aber the proposal form and/or for AeeENG Ime informed about thor other products and/or promotion actives, i) to colect, story Process, share and but not imited to reinsurers, surveyors, loss adjustors, loss assessors IT sence providers are ‘administrators, medical understand that | should be having DHA compliant insurance policy if or my dependents are holding Dubai visa and a Department of Heath, Abu Dhabi compliant insurance policy ior my dependents are holding an Abu DhabvAl Ain Visa.