Declaration

To be completed by the insured(s) shown and also on behalf of any other person to be covered by this insurance.

I declare that:

1. All information contained in this proposal and on any attachment is complete and correct;
2. I have disclosed all material facts to Lumley;
3. I agree that this proposal shall be the basis of the contract between me and Lumley and I am willing to accept the terms, conditions and exclusions of this insurance;
4. I am authorised to complete this proposal on behalf of all people to be covered by this insurance and they give the same declarations.

By signing this form I authorise the insurer to:

1. Check our details on the Insurance Claims Register and place our claims information on the Insurance Claims Register which other insurers can access;
2. Disclose our personal information about this insurance to other members of the insurance industry and/or parties who have a financial interest in the subject matter of this insurance;
3. Obtain our personal information held by any other party regarding my/our existing and previous insurances.