This “Medical Questionnaire Form (Long)” is prepared and issued by a company mainly to collect information for the employer/insured to determine ability to perform job duties and/or to analyse or evaluate employee’s compensation claims submitted in the future.
This “Medical Questionnaire Form (Long)” should be signed by the applicant/employee. |
Jurisdiction |
This form is intended for use in the UAE. |
Before Execution |
- The information on this front page or contained in the headers and footers of this instrument are for guidance purposes only. - Please delete this front page together with the information contained in the headers, footers and the endnotes prior to circulating this form. Where square brackets […] and highlights are used in the document, it indicates that there is missing or incomplete information which will need to be incorporated prior to signature. - Please remove the square brackets and all highlighting prior to signature. |