I declare that my answers in this application are true and complete and I understand that any material misrepresentation shall render the insurance voidable at the instance of the insurer, and that suicide within two years of the effective date is a risk not covered.
I understand and agree that this application form is void unless (a) I am a member of Doctors of BC or Yukon Medical Association (b) I am enrolled full time in medical school in British Columbia on the date of this application, (c) I am not presently on a personal or medical leave, and (d) I reside in Canada on the date of this application.
I understand that insurance will become effective on the later of the date my application for coverage is received by Doctors of BC or the date I begin medical school.
I authorize Manulife to hold a personal file about myself and my insurance coverage. I authorize Manulife, Doctors of BC, and their authorized staff, agents, representatives, advisors and service providers to use and exchange information needed for underwriting, financial management, administration and adjudication of claims under this insurance coverage with any person or organization who has relevant information about me including institutions, investigative agencies, insurers, and reinsurers.
I acknowledge and certify that I have read, understood and agree with the terms and conditions and declaration and authorization outlined above. I understand that checking this box constitutes my electronic signature of this application.