Take care to complete this form fully and correctly. Failure to disclose a material fact (any fact likely to influence the company’s acceptance and assessment of this proposal) will render the insurance void. If you are in doubt of the facts which might be considered material, you should disclose them. The liability of the company does not commence until AFC has accepted this proposal and the premium paid, except as any Office Certificate issued on behalf of the company.

*Minimum period of insurance is 4 months