When completing this form, we appreciate not everything is applicable. If this is the case on a section, please write NA.
If you need help, please call our office during business hours and we will get one of our staff to complete this over the phone for you or help you with any queries you may have.
YOUR DUTY OF DISCLOSURE
Before You enter into a contract of general insurance with an Insurer, You have a duty, under the Insurance Contracts Act 1984, to disclose to the Insurer every matter that You know, or could reasonably be expected to know, is relevant to the Insurer’s decision whether to accept the risk of insurance and, if so, on what terms. You have the same duty to disclose those matters to the Insurer before You renew, extend, vary or reinstate a contract of general insurance.
Your duty however does not require disclosure of matter:-
- that diminishes the risk to be undertaken by the Insurer;
- that is of common knowledge;
- that Your Insurer knows or, in the ordinary course of his business, ought to know;
- as to which compliance with Your duty is waived by the Insurer.
If You fail to comply with Your duty of disclosure, the Insurer may be entitled to reduce his liability under the contract in respect of a claim or may cancel the contract. If Your non disclosure is fraudulent, the Insurer may also have the option of avoiding the contract from its beginning.
PREVENTING OUR RIGHT OF RECOVERY
Where another person is liable to compensate You for any loss, damage or liability which is covered by this Policy but You have agreed not to seek recovery of any monies from that person, we will not cover You under this policy for that loss, damage or liability.
We are committed to protecting Your privacy. We only use the personal information You give us to quote on and insure Your risks. We only give personal information to: • our underwriters (and their representatives);
- our reinsurers (and their representatives); and
- people we appoint to assist us with any claims under Your policy.
We will not trade, sell or rent Your information.
If You don’t give us complete information, we cannot properly quote for Your insurance and we cannot insure You. You can check the personal information we hold about You at any time.
If You give us personal information about anyone else, we rely on You to notify them: • that You will give Your information to us;
- to whom we may give the information;
- the purposes for which we will use the information; and
- that they can access the information.
If the information You give us about someone else is sensitive, we rely on You to obtain their consent to disclosing it to us for the uses, and disclosure to the parties, we refer to in this statement.
I acknowledge that:
- I have read and understood the Important Information set out in the Proposal and I/we are authorised to make this proposal.
- All information given on this Proposal and any attachment is true and correct.
- The insurance contract will not commence until the premium is paid.
- The Insurer reserves the right to vary the premium and/or the policy terms and conditions on receipt of the completed proposal form.
- Up until a contract of insurance is entered into, I/We are under a continuing obligation to immediately inform Altiora Insurance Solutions of any change in the particulars or statements contained in this proposal or in any attachments.
- Although the signing of this proposal does not bind the Insurer or the Applicants to effect insurance, the Applicants acknowledge that the particulars and statements contained in this proposal and in the attachments shall be the basis of the contract should a policy be issued.
- The Proposal and attachments will be incorporated in the Policy.
I/We declare that the above answers are true to the best of My/Our knowledge and belief and that all material facts which may affect the assessment of the risk have been disclosed.
I/We agree that this proposal is for insurance in the standard terms and conditions of the Insurer’s policy and will be the basis of the contract.