Page 42 - iA Excellence -Field Underwriting Guide - Updated on July 2019

Preparing for your phone interview
or paramedical exam

Congratulations on purchasing a personal insurance contract with iA Excellence. You will be contacted shortly to
complete a declaration of health either through a phone interview or by a nurse coming to visit you to complete
a paramedical exam. The personal and medical information you will provide is necessary to determine your
insurability.

To help you prepare for this meeting, we are providing an outline of the topics you will be asked about:

Information that will be gathered during Information to have on
Topics
your interview hand
Prescription drugs - Reason?
- Since when? The list of your prescribed drugs
- Dosage? and dosage.
Visits to Your family - Date of your last visit? The full name and contact
physician - Reason for visit? details of the physician or
- Physician’s recommendations? office that can provide us with
- Are you awaiting treatment or your complete medical record,
results? including the date and reason
Specialist(s) - Date of your last visit? for your last visit.
- Reason for visit?
- Physician’s recommendations? The full name and contact
- Are you awaiting treatments or details of any specialist(s)
results? consulted in the past five years
and name of hospital where any
Alternative medicine - Acupuncturist, osteopath, surgery or special tests took
practitioner(s) chiropractor, etc. place.
Known medical conditions - Since when?
Lifestyle Smoking - Frequency?
Drinking - Quantity? Frequency?
- Type (beer, wine, liquor)?
Drug use - Quantity? Frequency?
- Type (marijuana, cocaine,
heroin)?
Future Foreign - Destination(s)?
travel - Trip length?
Criminal record - Date of conviction?
- Reason?
- Are you awaiting proceedings?
Driving record Loss of driver’s - When? Why?
license
Driving offences - How many? When? Why?

To ensure a smooth interview process, we recommend that you gather all relevant documents so that you have them on hand for
your meeting. Also, please remember that the interview/paramedical exam will take anywhere from 20 to 45 minutes.

iA Excellence is a trademark and business name under which
The Excellence Life Insurance Company operates. UD-PH1E 12-2016
42 APPENDIX B

For exclusive use by Financial Advisors