DRAFT Taxis & Ridesharing Online Application

Before submitting please read and agree to the terms of our Duty of Disclosure

You must tell us all information you know (or could reasonably be expected to know) which would influence the judgement of a prudent underwriter whether or not to accept your application, and if it is accepted, on what terms and at what cost.

Examples of information you may need to disclose include:

• any criminal convictions in the last 7 years or where imprisoned;
• if another insurer has cancelled or refused to renew insurance, or has imposed special terms;
• any insurance claim you have made in the past.

Examples of information you do not need to disclose include:

• anything we say you do not need to tell us about;
• anything that is common knowledge;
• anything you have already told us, or that we should be expected to know in the ordinary course of our business.

These examples are a guide only. If you are not sure whether you need to disclose a particular piece of information, please ask.

WHEN IN DOUBT – DISCLOSE. ALL INFORMATION WILL BE TREATED CONFIDENTIALLY.

1. Material Facts

(a) All information given to IUNZ (whether oral or written) is true and correct;

(b) All material facts have been disclosed. (See ‘Your Duty of Disclosure’);

2. Terms of Policy

The terms of IUNZ’s policy are accepted;

3. Use of Information

(a) My personal information collected by IUNZ may be:

(i) used by IUNZ to advise me of its other services;

(ii) disclosed to other members of the insurance industry and Insurance Claims Register Ltd., and to parties who have a financial interest in the subject matter of the policy;

(b) My personal information held by other members of the insurance industry and Insurance Claims Register Ltd., may be disclosed to IUNZ.

4. Agency

Anyone who assists me to complete this Application Form is acting as my agent only.

Please note:

• We gather information about you (including your claims history) to consider your application for insurance. If you refuse to provide it, we may decline your application.

• This information is held by us and you may access it. It may be passed onto other insurers you deal with, and mortgagees, etc.

• Your claims history is passed onto, and held by Insurance Claims Register Ltd. This enables other insurers you deal with to access it,
and prevent fraudulent claims.