Driver History (NOTE: It is your responsibility to ensure all answers provided are correct and complete, on behalf of yourself and all other drivers to be covered by this policy.)

I/we declare that:

• The Duty of Disclosure statement incorporated in this application has been read and understood by me/us.

• All answers and statements made in this application are true, complete and correct and that no information has been withheld.

• I/we have read and understood the application and policy.

• I/we understand that the "Notes" in this application are for my/our assistance, but I/we must read the Product Disclosure Statement and Policy Wording for full details of all policy terms, conditions and exclusions.

• I/we acknowledge Dawes Underwriting Australia Pty Ltd t/as Dawes Motor Insurance may give to, and obtain from, other insurers and/or insurance/financial reference bureau, parts or service providers, personal information relating to this application and/or policy as well as insurance claims information obtained during the currency of this policy.

• I/we understand that all drivers must be declared, otherwise cover will not apply.

• I/we understand that if I/we have elected to reduce the premium payable for this policy due to a restricted use of the vehicle, I/we must comply with the usage restrictions or the vehicle will not be insured.

• The answers provided are true, complete & correct on behalf of all persons to be insured.

• I/we have received or downloaded from the internet the Financial Services Guide, Product Disclosure Statement and Policy Wording.

• Before completing this application form, I/we have read and understood the Financial Services Guide, Product Disclosure Statement and Policy Wording.