| Document Date: 2010-11-30 15:13:35
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City New York / Portland / / Company MIB Inc. / Medical Information Bureau Inc. / The Standard Life Insurance Company / Immune Deficiency Syndrome / / Event Name Change / / Facility Group Group Number Columbia University / AIDS-Related Complex / University Medical History Statement / Medical Facility / / IndustryTerm insurance coverage / insurance / / MedicalCondition HIV infection / pneumonia / A. High blood pressure / F. Blindness / HIV / arteriosclerosis / nervous system disorder / G. An immune system disorder / D. Arthritis / C. Cancer / stroke / nephritis / diabetes / cardiovascular disease / sickness / persistent cough / persistent fatigue / injury / deafness / muscle disorder / epilepsy / depression / Injuries / Disorders / / MedicalTreatment surgery / / Organization Columbia University / Current Amount In Force / Medical Information Bureau / / Person Salary Check / Spouse / / / Position plan administrator / authorized representative / upon request / physician / No No No Yes Yes No No Yes Yes No No Yes Yes Yes No No No Physician / / ProvinceOrState Oregon / / URL www.mib.com / /
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Reset Columbia University Medical History Statement (Evidence of Insurability) The Standard Life Insurance Company of New York Medical Underwriting, 900 SW Fifth Avenue Portland OR[removed]