4 | 4 Investment Policy Tigris By Discovery

Occupation

Please provide details about your occupational duties and how your time is allocated.

Occupational Duties

Brief description of your occupational duties Keep this concise and factual. This information is used for underwriting risk assessment.

Time Allocation

Please give a breakdown of the percentage of time spent on different functions within your occupation in an 8-hour day.

Functions

Examples

Percentage (%)

Desk-bound and office-bound tasks

Data capturing, filing

Supervising staff within the office

Admin manager, call centre manager

Travelling (excluding home to work)

Driver, visiting clients

Supervising staff on site, in a factory, or during field work

Building contractor, factory foreman, storeroom supervisor

Light manual work

Hairdresser, teacher, jeweller

Moderate manual work

Plumber, electrician, mechanic

Heavy manual work

Miner, farrier, diesel mechanic

The total of all percentages should equal 100%.

Beneficiaries & Dependants

Keep the form clean: only add dependants/beneficiaries when needed.

Dependants

Add only if applicable.

Testament (Will)

Do you have a testament (Will)?

Note: This section captures additional info only and may not be mapped to the PDF fields.

Beneficiaries

Trusts: choose Existing Trust (legal entity) or Testamentary Trust.

Medical & Mental Health Details

Medical Information

Height (without shoes) — meters

Weight (with clothes) — kg

Medical Questions

1. Have you ever had unintentional weight loss of more than 5 kg? If Yes, please give details.

Yes

Details

Doctor

Date of last symptoms

2. Do you exercise regularly? If Yes, please give details.

Yes

Details

Doctor

Date of last symptoms

3. Do you use chronic and regular medicine? If Yes, please list the medicine that you use. Please include sleeping tablets, oral contraceptives, and any non‑prescription medicine, even when not used daily.

Yes

Details

Doctor

Date of last symptoms

4. Have you been diagnosed or treated for any benign or malignant (cancerous) tumour or growth, for example moles, skin cancer, breast cancer, prostate cancer or colon cancer?

Yes

Details

Doctor

Date of last symptoms

5. Any porphyria, haemochromatosis, spleen, lymph or blood disorder, swollen glands or lymph nodes, bleeding disorder or clotting disorder, leukaemia or lymphatic cancer, for example anaemia, thalassaemia, polycythaemia, haemophilia, idiopathic thrombocytopenic purpura (ITP), protein C or S deficiency, Von Willebrand’s disease, antiphospholipid syndrome, thrombocytopenia, leukaemia, lymphoma or myeloma?

Yes

Details

Doctor

Date of last symptoms

6. Any disorders of the heart, for example rheumatic fever, heart murmur or heart‑valve problems, palpitations or arrhythmia, chest pain, angina, heart attack, heart failure, myocarditis, cardiomyopathy, an abnormal ECG, or open/keyhole heart surgery or procedures?

Yes

Details

Doctor

Date of last symptoms

7. Raised cholesterol, high blood pressure or any diseases of the blood vessels or circulatory system, for example aneurysm, pain in legs when walking, deep‑vein thrombosis (DVT) or pulmonary embolism?

Yes

Details

Doctor

Date of last symptoms

8. Any disorders of the nervous system, for example epilepsy or any convulsion, transient ischaemic attack (TIA), stroke, brain aneurysm, blackouts, chronic or regular headaches, Parkinson’s disease, multiple sclerosis, myasthenia gravis, dementia, hydrocephalus or raised intra‑cranial pressure, motor neuron disease or any other type of weakness or paralysis?

Yes

Details

Doctor

Date of last symptoms

9. Have you ever been diagnosed or treated for fibromyalgia, chronic fatigue syndrome or any chronic pain disorders?

Yes

Details

Doctor

Date of last symptoms

10. Have you ever been diagnosed, investigated or treated (by means of counselling or medication) for stress, insomnia, anxiety, depression, bipolar mood disorder, panic attacks, post‑traumatic stress disorder, obsessive‑compulsive disorder, any eating disorder or any other psychiatric or emotional disorders?

Yes

Details

Doctor

Date of last symptoms

11. Disorders of the digestive system, for example oesophageal stenosis, achalasia, perforated or bleeding ulcer, Barrett’s oesophagitis, any hernia, irritable bowel syndrome (IBS), spastic colon, diverticulitis, inflammatory bowel disease, Crohn’s disease or ulcerative colitis, colon polyps, rectal bleeding, recurrent diarrhoea, chronic gastroenteritis, fatty liver, abnormal liver functions or coeliac disease?

Yes

Details

Doctor

Date of last symptoms

12. Have you ever been diagnosed, investigated or treated for any connective‑tissue disorder, or any autoimmune disorder, for example rheumatoid arthritis, systemic lupus erythematosus (SLE), ankylosing spondylitis, scleroderma, sarcoidosis, Sjögren’s syndrome, polymyositis, dermatomyositis, Wegener’s granulomatosis, Ehlers–Danlos syndrome or Marfan syndrome?

Yes

Details

Doctor

Date of last symptoms

13. Any disorders of your kidneys or bladder, like kidney stones, renal failure, nephritis, recurrent infections or abnormal urine tests (such as blood or protein in the urine)?

Yes

Details

Doctor

Date of last symptoms

14. Respiratory problems, for example asthma, chronic bronchitis, emphysema, persistent coughing, recurrent lung infections, cystic fibrosis, bronchiectasis, lung fibrosis, interstitial lung disease, sleep apnoea, occupational lung disease, pneumonia, sarcoidosis or an abnormal lung function test?

Yes

Details

Doctor

Date of last symptoms

15. Have you ever been admitted to hospital due to a COVID‑19‑related infection, or do you currently have a COVID‑19‑related infection, or have any ongoing symptoms, or require ongoing treatment or monitoring after a COVID‑19‑related infection?

Yes

Details

Doctor

Date of last symptoms

16. Do you know your HIV status?

Yes

16.1 If Yes, when was your last test?

16.2 Where was the test performed?

16.3 What was your result?

16.4 Have you ever used any treatment for HIV/AIDS? If Yes, what was the indication for treatment and how long was the treatment used?

17. Any back, joint, bone, muscle or chronic skin conditions, for example back or neck problems or injuries (including muscle spasms and slipped disc), osteoarthritis, gout, septic arthritis, psoriatic arthritis, fracture, joint injury, osteoporosis or osteopenia, dermatitis, eczema or psoriasis?

Yes

Details

Doctor

Date of last symptoms

18. Have you ever been diagnosed or treated for diabetes mellitus, impaired fasting glucose, insulin resistance or pre‑diabetes, or have you ever been diagnosed or treated for thyroid, parathyroid or pituitary gland problems, or any other endocrine disorders such as diabetes insipidus, Cushing’s disease or Addison’s disease?

Yes

Details

Doctor

Date of last symptoms

19. Any eye, ear, nose or throat disorder, for example glaucoma, keratoconus, retinal detachment, optic neuritis, uveitis, scleritis, vision loss or blindness, tinnitus, hearing loss or deafness, vertigo or loss of balance, or chronic hoarseness?

Yes

Details

Doctor

Date of last symptoms

20. Have you ever had any abnormalities of the male genital tract, for example prostatitis, benign prostatic hyperplasia (BPH) or abnormal prostate‑specific antigen (PSA) blood test?

Yes

Details

Doctor

Date of last symptoms

21. Have you ever had any abnormality of the breasts, including abnormal mammogram or sonar, breast biopsy or surgery?

Yes

Details

Doctor

Date of last symptoms

22. Have you ever had any disorders of the female reproductive organs (ovaries, fallopian tubes, uterus, cervix, etc.), including an abnormal Pap smear, cysts and endometriosis?

Yes

Details

Doctor

Date of last symptoms

23. Have you had any complications due to a previous or current pregnancy, for example pre‑eclampsia, abnormal bleeding, miscarriages or depression?

Yes

Details

Doctor

Date of last symptoms

24. Are you currently pregnant, and if so, how many months?

Yes

Details

Doctor

Date of last symptoms

GENERAL HEALTH DISCLOSUR

25. Have you ever been diagnosed with, or are you currently experiencing symptoms associated with, any sexually transmitted diseases (STDs): herpes, human papilloma virus (HPV), chlamydia, gonorrhoea, cytomegalovirus, etc.?

Yes

Details

Doctor

Date of last symptoms

26. If not already mentioned, have you had any of the following special investigations: genetic testing, tumour markers, biopsy, angiogram, MRI or CT scan, normal or abnormal back or neck X‑rays, abnormal X‑rays of any other body part?

Yes

Details

Doctor

Date of last symptoms

27. If not already mentioned, have you had any operations (including surgery to assist in weight loss), disability, accidents with injuries, hospital admissions for medical or surgical reasons, or are you aware of any future surgery, treatment or investigations that you need?

Yes

Details

Doctor

Date of last symptoms

28. Are you awaiting results for any special investigations that have recently been done, or are you planning to seek medical advice for any symptoms or conditions that you have?

Yes

Details

Doctor

Date of last symptoms

29. Has a proposal for assurance for health, life, severe illness (dread disease), disability insurance, functional impairment or income continuation ever been declined, deferred or accepted with certain provisions, for example premium loading or any exclusions?

Yes

Details

Doctor

Date of last symptoms

30. Have you been off work for more than seven consecutive days due to medical reasons in the last two years?

Yes

Details

Doctor

Date of last symptoms

31. Have you ever been medically boarded, or submitted a claim for short‑term or long‑term disability, severe illness (dread disease) or third‑party benefits?

Yes

Details

Doctor

Date of last symptoms

32. Are there any aspects of your job that exacerbate or trigger any symptoms or conditions (such as allergens, stress, manual work, standing or sitting for long periods or exposure to cold environments)?

Yes

Details

Doctor

Date of last symptoms

33. Have you ever experienced any difficulty or inability to perform your usual daily activities (including all aspects of your occupation), or did you have to adjust your duties or activities, as a result of any medical or surgical condition?

Yes

Details

Doctor

Date of last symptoms

34. Are there any other circumstances not disclosed on this form which may affect the risk of insurance on your life?

Yes

Details

Doctor

Date of last symptoms

FAMILY HISTORY

35. Are you adopted or do you have limited family history? If Yes, please provide more information.

Yes

Details

36. Have any of your family (mother, father, siblings) passed away before the age of 50 from natural causes (any disease or illness)?

Yes

Add a family member

Enter the family member, age at death, and cause. Click Add. You can add up to 8 rows.

0 added

Family member

Age at death

Cause of death

Family member	Age	Cause	Action

37. Have any members of your direct family (mother, father, siblings), whether alive or deceased, been diagnosed or treated for breast cancer, colon cancer or any other familial cancer?

Yes

Details

Doctor

Age at diagnosis

38. Have any members of your direct family (mother, father, siblings), whether alive or deceased, been diagnosed or treated before the age of 50 for coronary artery disease (for example chest pain or heart attack), peripheral vascular disease (problematic circulation to the lower limbs) or stroke?

Yes

Details

Doctor

Age at diagnosis

39. Have any members of your direct family (mother, father, siblings), whether alive or deceased, been diagnosed or treated for any neurological disorder, motor neuron disease or muscular dystrophy (for example Huntington’s disease, Parkinson’s disease, multiple sclerosis or Alzheimer’s disease)?

Yes

Details

Doctor

Age at diagnosis

40. Have any members of your direct family (mother, father, siblings), whether alive or deceased, been diagnosed or treated for polycystic kidneys?

Yes

Details

Doctor

Age at diagnosis

41. Have any members of your direct family (mother, father, siblings), whether alive or deceased, been diagnosed or treated for retinitis pigmentosa?

Yes

Details

Doctor

Age at diagnosis

42. Have two or more members of your direct family (mother, father, siblings), whether alive or deceased, been diagnosed or treated for diabetes?

Yes

Details

Doctor

Age at diagnosis

43. Have any members of your direct family (mother, father, siblings), whether alive or deceased, been diagnosed or treated for psychiatric disorders?

Yes

Details

Doctor

Age at diagnosis

44. Have any members of your direct family (mother, father, siblings), whether alive or deceased, been diagnosed or treated for any other familial disease not mentioned above?

Yes

Details

Doctor

Age at diagnosis

Bank Account Information

Account Holder Name

Account Type

Bank Name

Account Number

Branch Code

Branch name

Policy Reference

Requires Second Signature?

Yes

Consent & Declarations

Full Name

Identification Number

Personal Capacity?

Yes

Representing (if not personal)

Phone Number

Email Address

Signed Date

Review Your Application

Please review all information before submitting. All required fields must be completed. Once you submit, you will not be able to edit this information.

Signature

Please sign below to confirm that the information provided is accurate and that you authorise us to proceed with document generation.

4 | 4 Investment Policy Tigris By Discovery

Primary – Individual Details

Address

Postal / Mailing Address

Physical / Street Address

Extended Details

Discovery Integrator

Discovery Vitality

Discovery Bank

Occupation

Occupational Duties

Time Allocation

Financial & Lifestyle Details

Assets & Liabilities

Travel History

Disability & Current Benefits

Other Annual Income

Lifestyle & Physical Details

Underwriting Questions – Lifestyle (Principal)

General Practitioner Details

Beneficiaries & Dependants

Dependants

Testament (Will)

Beneficiaries

Medical & Mental Health Details

Medical Information

Medical Questions

GENERAL HEALTH DISCLOSUR

FAMILY HISTORY

Bank Account Information

Consent & Declarations

Review Your Application

Signature