Insurance built
for the people
who care.

By signing this application form You hereby declare that:

• you have received, read and understood the policy wording, in particular your duty of disclosure and what is excluded
• you agree to be bound by the terms and conditions
• the disclosed information is true and correct
• you have not withheld or suppressed any information concerning the details in this application
• if there is more than one insured and all have not signed this application, you are authorised to sign for and on their behalf

You consent to the use and disclosure of your personal information for the purposes shown in the Privacy section of our Policy Wording and our Privacy Statement.

You confirm that if you have disclosed personal information about any insured person or any other person you have made them or will make them aware that you have provided their personal information to us and the types of third parties we may provide it to, the relevant purposes we and third parties will use it for, and how the Insured Person or other person can access it.