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Parachuting/Sky Diving/Base Jumping/Sky Surfing/ Wingsuit Flying Questionnaire

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Parachuting/Sky Diving/Base Jumping/Sky Surfing/ Wingsuit Flying Questionnaire Canada Life Group Insurance Parachuting/Sky Diving/Base Jumping/Sky Surfing/ Wingsuit flying Questionnaire We do not need to be advised of one-off events with no expectation of parachuting in the future. 1. Your details Surname Forename(s) Date of birth DD / MM / YYYY 2. Participation Which of the following do you participate in? If Yes, please advise number of jumps per year. Please tick Yes or No to all. Parachuting Yes No Number of jumps per year Sky Diving Yes No Number of jumps per year Base Jumping Yes No Number of jumps per year Sky Surfing Yes No Number of jumps per year Wingsuit flying Yes No Number of jumps per year Do you jump as an instructor? Yes No Number of jumps per year 3. Records and displays Do you intend to take part in Yes No record attempts or competitions? If ‘Yes’, please complete the table below. What is the record attempt? Location Date of attempt(s) DD / MM / YYYY Do you take part in public displays? Yes No If ‘Yes’, please complete the table below. Type of display Exact location Frequency 1 Canada Life Group Insurance 4. Data Protection Notice (DPN) Canada Life Limited (referred to as ‘Canada Sharing personal information Retention of your personal data Life’, ‘we’, ‘us’ or ‘our’ in this DPN) takes its We share personal information only on the basis We will keep your personal data only for so long as privacy obligations very seriously. Any personal of the purposes for which it was collected. This is necessary and for the purpose for which it was information provided to us, as data controller, notice is intended to illustrate the instances where originally collected. In particular, for so long as by a policyholder, joint policyholder, employer data may be shared. However, we will share your there is any possibility that either you or we may policyholder, trustee, insured person, beneficiary, data only for the limited and compatible purposes wish to bring a legal claim under this insurance, or claimant or member (referred to as ‘you’ or for which it was originally obtained: where we are required to keep your personal data ‘your’ in this DPN), will be treated in accordance due to legal or regulatory reasons. with the Data Protection Act 2018. O with other Canada Life group companies including those outside the European Economic Area (EEA); YOUR RIGHTS AND CONTACT DETAILS OF Using Personal Information THE INFORMATION COMMISSIONER’S O with any of our service providers, reinsurers We use personal information to undertake OFFICE (ICO) activities relating to the setting up, administration and / or regulators; You may have the right to require us to: and renewal of our policies, products and O with other insurers and government agencies, services. This includes processing applications including without limitation Her Majesty’s O provide you with further details on the use and handling any claims. For the majority of our Revenue and Customs (HMRC), Department of we make of your personal information or your business we will rely on the performance of our Work and Pensions (DWP); special categories of data; contractual arrangements with you as the legal O in order to prevent, detect or investigate O provide you with a copy of the personal basis for processing. financial crime including fraud or other criminal information that you have provided to us or We do not use policyholder or member personal activity, we may share your data with other which we hold; data for marketing purposes and we do not make companies (including private investigators), O update any inaccuracies in the personal your personal information available to third parties organisations (including fraud prevention information we hold; agencies and databases), public bodies for the purpose of direct marketing. O (including the police) and associations and delete any special category of data or personal The nature of our business is to provide credit reference agencies; information for which we no longer have lawful grounds to use; investments, life and pensions cover, critical O we will not share your medical information O illness, income protection and employer related with anyone other than yourself without your cease processing of your personal information group products. To do this we need to use consent except as described in the next bullet that is based on consent, by withdrawing your the personal information provided to carry out point. This includes your employer, spouse, consent to that particular processing; analysis of actuarial risks (risks of gains or losses), other relatives, friends or your legal or financial O cease any processing based on legitimate mortality and morbidity risks and pricing. This will adviser. In some circumstances, it may be interests grounds, unless our reasons for be carried out in accordance with the Institute & appropriate to advise your employer about undertaking that processing outweigh any Faculty of Actuaries’ data handling protocols. your medical information, for example, to prejudice to your data protection rights; and We use underwriting software to process some recommend alternative supportive therapy. O restrict how we use your personal information applications and quotations which will use an However, we will seek your consent in such whilst a complaint is being investigated. circumstances; element of automated decision making. In certain circumstances, we may need to restrict O for employer-related products and services Exceptionally, we may rely on our legitimate the rights listed above in order to safeguard the only, some medical information related to interests to process your personal data. When public interest (e.g. the prevention or detection underwriting decisions and non-medical we do, we will demonstrate compelling legitimate of crime), our interests (e.g. the maintenance of information about you necessary for lawful grounds for doing so. our legal responsibilities) and for the performance policy and claim administration purposes will of our contract with an employer who is the For employer-related group insurance be shared with your employer; policyholder for employer-related products and products O we will not share non-medical information services. The Data Protection Act permits appropriate concerning you with your spouse, other information about employees to be provided by relatives, friends or your legal or financial Data Protection Officer (DPO) adviser unless you provide your consent to us an employer to an insurer without individual If you have any questions, or complaints, in in writing; consent (including details of long-term absentees, relation to our use of your personal information, current and previous claimants, and medical O for insurance related products, with your own you should first contact our DPO, on the details underwriting decisions). doctor or relevant medical professionals; and/ below: or For employer-related group products the Data Canada Life Limited, Group Insurance, O in any circumstances if permitted or required Protection Act permits that members may 3 Rivergate, Temple Quay, Bristol, BS1 6ER to do so by law or if we have your consent to individually withdraw their consent, In those or by email at: [email protected]. instances Canada Life will be unable to provide do so. cover for that individual. In the unlikely event that you are dissatisfied International Transfers with our response, you have the right to take the When medically underwriting or assessing a claim Given the global nature of our business, we use matter up with the Information Commissioner’s we will obtain consent from the employee. third party suppliers and outsourced services Office (ICO), whose address is: (including cloud based services), which can Information Commissioner’s Office, require transfers of personal information outside Wycliffe House, Water Lane, of the EEA. In doing so, we ensure that there are Wilmslow Cheshire, SK9 5AF appropriate contractual arrangements and we will choose only those organisations with strict The full version of our DPN can be found on our controls in place, via appropriate organisational website, www.canadalife.co.uk or is available and technical measures in place to protect your upon request by calling 0345 223 8000. personal information. This DPN is dated 5th March 2018. Any future updates will be made available as described above. 2 Canada Life Group Insurance 5. Your Declaration I confirm that I have answered the questions in this questionnaire honestly and have taken reasonable care to ensure those answers are correct. I confirm that in the period before the acceptance of this cover, I will inform Canada Life of any matter or fact that would make the answers to the questions in this questionnaire incorrect or untrue. I agree to Canada Life using and sharing my personal information as set out in our data protection notice. A copy of this notice can be found on our website, www.canadalife.co.uk or is available on request by calling 0345 223 8000. Signed Date (day, month, year) 2 0 Our forms are available to download from our website: www.canadalife.co.uk/group Canada Life Limited, 3 Rivergate, Temple Quay, Bristol BS1 6ER. Telephone 0345 223 8000 Canada Life Limited, registered in England no. 973271. Registered Office: Canada Life Place, Potters Bar, Hertfordshire EN6 5BA. CLFIS (UK) Limited, registered in England no. 04356028 is an associate company of Canada Life Limited. Registered Office: Canada Life Place, Potters Bar, Hertfordshire EN6 5BA. Canada Life Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. GRP707 – 1218R 3.
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