I/We hereby declare that:

My/Our attention has been drawn to the Important Notice of this Proposal form and further I/We have read these notices carefully and acknowledge my/our understanding of their content by my/our signature/s below.

The above statements are true, and I/we have not suppressed or misstated any facts and should any information given by me/us alter between the date of this Proposal form and the inception date of the insurance to which this Proposal relates I/we shall give immediately notice thereof.

I/We authorise you, to collect or disclose any personal information relating to this insurance to/from any insurers or insurance reference service. Where I/we have provided information about another individual I/we declare that the individual has been or will be made aware of that fact.

I/we also confirm that the undersigned is/are authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this Proposal form, and I/we complete this Proposal form on their behalf.

Where a Policy is issued on a “minimum and deposit” premium basis, the annual premium is a minimum and deposit premium, which means that there is no refund of any premium or fees and charges in the event you cancel the policy before the normal expiry date or the policy is cancelled by the insurer prior to the normal expiry date. By signing this proposal form you acknowledge your understanding and acceptance of this condition.