PLEASE READ BEFORE SIGNING:
A claim will become invalid and the lnsured's right of recovery is forfeited where (a) an Applicant for this contract gives false particulars
to the prejudice of the insurer or knowingly misrepresents or fails to disclose any fact In any part of this application required to be stated therein; or (b) the insured fails to
inform material changes to these facts during the term of the contract; (c) the insured contravenes a term of the contract or commits a fraud; or (d) the insured willfully makes
a false statement in respect of a claim.
The Applicants have reviewed all parts and attachments of this application and acknowledge that all information is true and correct and understand that this application
for insurance is based on the truth and completeness of this information.
The personal information provided in this document and in the future including, but not limited to, credit information and claims history may be collected, used and
disclosed by the lnsured's representative or insurance company, subject to local legislation, for the purpose of communicating with the insured or their representative,
assessing the application for insurance and underwriting any such policies, evaluating claims, detecting and preventing fraud, and analyzing business results. I confirm that
all individuals whose personal information is contained in this document have authorized that I agree to the above on their behalf.