I/We hereby apply for insurance to Covea Insurance plc (the insurer) under their usual terms and conditions. I/We confirm that the information supplied by me/us in connection with this proposal is correct to my knowledge and belief. I/We note that I/We should keep a record of all information supplied for the purpose of this proposal and that a copy of such information will be supplied if requested by me/us.
I/We consent to the seeking of information from other insurers and I/We authorise the giving of such information for such purposes. I/We also consent to the insurer or their agents seeking medical information from any doctor who at any time has attended me concerning anything which affects my physical or mental health and I/ We authorise the giving of such information.
Notice under the Data Protection Act 1988 and 2003
I/We confirm and agree that information about me/us and this Proposal may be retained on paper and computer by APRIL Ireland and used:
A. by Covea Insurance plc, APRIL Ireland and other businesses that provide insurance services relating to the proposal as may be necessary for the administration of my/our policy and dealing with claims. In dealing with claims under my/ our policy I/We agree that it may be necessary for APRIL Ireland to obtain and use sensitive personal information about me/us.
B. to provide information about me/us (whether provided in the proposal or claim form) to other insurers for the prevention of fraud and to other third parties for the purpose of administration of their policy or any claim. Details of such third parties and other insurers will be made available on request.
I/We have been provided with details of the procedure to follow in the event of a complaint.
Your contact information may be used to send you details about other products and services available from APRIL Ireland that might interest you. If you do not wish to receive this information please tick this box.
Warning: The current premium may increase with 30 days notice.