I/we agree the information provided in connection with this proposal, whether in my/our hand or not, is true and I/we have not withheld any material facts.
I/we understand that non-disclosure or misrepresentation of a material fact will entitle Insurers to void any insurance granted.
(A material fact is likely to influence the acceptance or assessment of this proposal by insurers. If you are in any doubt as to what constitutes a material fact you should consult us your insurance broker)
I/we understand that the signing of this proposal does not bind me/us to complete the insurance but agree that should a contract of insurance be concluded, this proposal and statements herein shall form the basis of such contract.
If any answer has been written by any other person, such person shall for that purpose be regarded as my/our agent and not the agent of the insurer.
I/we agree that I/we have read the completed form in full and accept responsibility for the answers.