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Step 1 of 5
I hereby represent and warrant that the information provided in connection with this proposal, whether in my own hand or not, is true and I have not withheld any material facts. I understand that non-disclosure or misrepresentation of a material fact will entitle Underwriters to avoid this Insurance. I also understand that the insurers are relying upon the information contained in this proposal and that this proposal is incorporated into any policy that will be issued.
(A material fact is one likely to influence acceptance or assessment of this proposal by Underwriters. If you are in any doubt as to whether a fact is material or not, you must disclose it in the space below)
I understand that signing of this proposal does not bind me to an insurance contract but agree that, should a contract of insurance be concluded, this proposal and the statements made therein shall form the basis of the contract.
You should keep a record (including copies of any letters) of all information supplied to Underwriters for the purpose of entering into this Insurance. A copy of your completed proposal will be available (on request) provided the Insurance is effected.
You must inform us of any change in circumstances will will materially affect this Insurance.
