NOTE:- By completing this form you are confirming that:

  • An insurer has never refused insurance, imposed special terms, refused renewal or cancelled a policy.
  • In the last 3 years your company has not been taken over, merged, disposed of or acquired a company or significant business activity for which this proposal is      being considered?
  • Your business, you, your partners, directors or employees have not been involved in any legal disputes, action, prosecution, Customs & Excise dispute, Inland Revenue investigation or DSS review during the last 5 years.
  • You confirm that neither you, or any business director or partner to be insured have:

a. Been convicted of or not yet charged for any criminal offence

b. Either personally or in a business capacity been declared bankrupt, insolvent or gone into liquidation.

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