Declaration by person applying

I declare that the motor vehicle described above will be kept in an efficient and roadworthy condition, and that the above information is true, correct and complete, otherwise, I understand that you may make this policy void or refuse a claim.

I agree that this application and other statements, information or declaration I have made or which has been made on my behalf (including declarations made over the phone and internet) will form the basis of the contract of insurance between me and you (Income).

I understand and agree to the 'Personal data collection statement'. You will not be legally responsible for any claims until you have accepted this application and I have paid the premium in full.

I agree that if I or any *Relevant Person is found to be a +Prohibited Person, you are entitled not to accept this application. Further, if any policy is issued, you will end this policy, not pay any benefit or allow any transaction to be carried out under this policy such as assignment, if I or any Relevant Person is a Prohibited Person, and your decision will be final. You will not refund any unutilised premium when this policy is ended. I will inform Income immediately if there is any change in my or any Relevant Person’s identity, status or identity documents.

*Relevant Person includes insured, trustee, assignee, beneficiary, beneficial owner or nominee and mortgagee or financier.
+Prohibited Person means a person or entity who is subject to laws, regulations or sanctions administered by any governmental or regulatory authorities or law enforcement in any country, which will prohibit you from providing insurance cover or paying any benefit.