SOCIETY SUBSCRIPTIONS

Rank/Salutation & Full Name:

Permanent Address (including post code):

Names & dates of birth of all dependent children:

I hereby apply for membership of the REOWS In the event of my application being accepted, I undertake to conform in all respects to the Rules of the Society available above (particular attention is drawn to para 3.7). I understand that this application forms the basis of the contract between myself and the REOWS. I undertake to let the Secretary know any changes to my relationship status, dependent children & contact details (personal email and mobile number) understanding that failure to do so could result in underpayments and, consequently, reduced levels of death benefits and/or loss of membership.

Health Declaration: Is your current Medical Employment Standard lower than P3 MLD(T)? Yes No If your MES is lower than P3 MLD(T) and/or the answer to either of the medical questions below is “Yes”: - you must contact Secretary REOWS by email (secretary@reows.co.uk) or telephone (01634 409110) before submitting the application. - you will be asked to provide supplementary information to support your answer(s). Membership will not be considered until this has been provided.

1. Do you have or have ever suffered from: any form of cancer, blood pressure that is currently being treated with medication, kidney disease, diabetes, stroke or brain haemorrhage, circulatory problems, disease or disorder of the brain or of the spinal cord or nerves, or of the heart, arteries, veins or valves? Yes No

2. In the last two years, have you been referred to, or are expecting to be referred to a medical specialist or consultant for treatment or advice for any condition other than musculoskeletal? Yes No

Medical Information Consent I am aware that if any of the information I have provided is not truthful, accurate and correct and this might have reasonably affected the decision to provide cover for me my policy may be amended or cancelled, or a claim may be rejected or not fully paid. I consent to the REOWS requesting and obtaining medical information from my GP (either Defence Primary Health Care or civilian) for the purposes of assessing a claim.

Direct Debit Set Up I have completed a Direct Debit Mandate Click here to open the direct debit mandate. Your application cannot be considered until the mandate has been successfully completed. Your payment schedule will be sent to you before the initial subscription rate is set up.

Data Consent for Applicant and Dependents I consent to the REOWS holding and using such personal information about me as is required for the administration of my membership and the processing of claims for my dependants. I consent to the REOWS holding and using such personal information about my dependants aged under 18 listed overleaf as is required for the processing of claims on their behalf. I understand that without this consent being given, the relevant dependant(s) will not be covered by this policy. Consent for use of adult dependants' information (e.g. spouses, and children over 18) can only be given by the dependants themselves. To give consent, please ask your dependant (over 18) to email secretary@reows.co.uk using "Data Consent" as the subject. The email should state: ‘I have read the privacy statement and consent to the REOWS holding and using such personal and healthcare information about me as is required for the processing of claims on my behalf.’

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