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Personal
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Declaration

You have never been convicted of or charged (but not yet tried) with any criminal offence other than motoring offences and have never been declared bankrupt/insolvent, or the subject of bankruptcy proceedings.
You have never had a proposal for accident, illness, medical or life insurance refused or declined and you have never had an insurance cancelled, renewal refused or had special terms imposed.
You have not, in the past 12 months, sought medical advice for any condition or injury which has resulted in you being unable to work for more than 14 days.
You have never suffered from any recurring, intermittent, acute or chronic disease, condition or disorder.
You have never suffered from back pain, heart disease, anxiety, depression or mental illness.
​You are not currently undergoing any medical treatment.

Stonier Insurance is a trading name of J Stonier & Son

J Stonier & Son is authorised and regulated by the Financial Conduct Authority under firm reference 300770

101 Chester Road, Macclesfield, Cheshire SK11 8DL