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Declaration (Please read)


I, the undersigned, hereby apply for Legal Cost Insurance on the Policy Terms and Conditions. 2. I understand that the Policy will incept upon payment of the first Premium and Administration Fee. 3. I acknowledge that the payment of Premiums on the due dates is my responsibility. 4. I hereby authorize the Insurer and its agent(s) to debit my bank account, with amounts due until cancellation of the Policy. 5. I undertake to notify the Insurer of any changes to my particulars. 6. I understand that any misrepresentation or non-disclosure could lead to loss of benefits, forfeiture of Premiums and cancellation of the Policy. 7. I authorize the Insurer and its business partners to access and use my personal information. 8. I choose the above as my address for service of legal documents. 9. I hereby declare that the bank account above is my bank account. 10. I understand that the Legal cost of any Legal Proceeding arising from an Insured Event which occured before the Date of Cover will not be covered. 11. I, the undersigned confirm that I have read this declaration, understand its contents and implications and personally signed it.


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