I/We the undersigned duly authorised person(s) declare that:
i. I am/we are authorised by each of the Proposers to sign this Proposal Form; and
ii. the above statements are correct, true and complete; and
iii. no information material to this Proposal Form has been withheld; and
iv. I/we have read the important facts which you have put before me/us and I/we understand the advice given in relation to the duty of disclosure; and
v. I/we have diligently made all necessary and detailed enquiries in order to comply with the duty of disclosure; and
vi. I/we understand that no insurance is in force until such time as the insurer has confirmed acceptance of the proposed insurance; and
vii. I/We undertake to inform the insurer of any material alteration to these facts occurring before completion of the contract of insurance; and
viii. I/we acknowledge that the Insurer relies on the information and representations in this Proposal Form and otherwise made by me/us in relation to this insurance.
This application form will be used to create a letter of offer for the nominated insurances you have selected. Upon your acceptance of this offer we will create the rest of documents (invoice / certificate of currency etc).
Send all correspondence to: Martial Arts Australia Insurance Services
Office: 6 / 12 Henderson Road, Knoxfield VICTORIA
Postal: P.O Box 2057 Blackburn South VICTORIA 3130
DISCUSS - P: 03 8201 9908 URGENT: 0451 331 958 (Text 24/7)