IMPORTANT NOTE:
READ THIS AGREEMENT BEFORE ACCEPTING THIS PROPOSAL.
| Agreement: I agree that: |
| 1 Material Facts: |
| a) All information given to NZI (whether oral or written) is true and correct. |
| b) All material facts have been disclosed. |
| 2 Terms of Policy: The terms of NZI's policy are accepted. |
| 3 Use of Information: |
| a) My personal information collected by NZI may be: |
| 1 Used by NZI to advise me of its other services. |
| 2 Disclosed to other members of the insurance industry and Insurance Claims RegisterLtd. 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 NZI. |
| 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 can access it. It may be passed on to other Insurers you deal with and mortgagees etc. |
| Your claims history is passed on to, and held by Insurance Claims Register Ltd. This enables other Insurers you deal with, to access it and prevents fraudulent claims. |
YOUR DUTY OF DISCLOSURE |
Before you enter into a contact of insurance with NZI you have a duty to disclose to us every material fact which would influence our decision whether to accept your application for insurance cover and, if so, on what terms. Once insurance cover has been issued you have the same duty to disclose to us any material change in facts as they occur. your duty however does not require disclosure of any matter:
That reduces the risk
That is of common knowledge
That we know, or in ordinary course of business, should know
Where we especially say so
|
| WHEN IN DOUBT DISCLOSE |
| If you fail to comply with your duty of disclosure we are entitled to declare the contract of insurance of no effect and reject any claim you make. |
NON-DISCLOSURE |
| If you are not sure whether or not a particular matter should be disclosed to us, it is best to disclose the details. All information will be treated confidentially. |
| Please tick the box to accept these terms and conditions. |