EPS Contractors Liability Insurance Programme

PRIVACY STATEMENT

i2i Brokers are bound by the obligations of the Privacy Act 1993 regarding the collection, use, disclosure and handling of your personal information.  We will protect the privacy of your personal information.  We will use the information you provide in this Declaration Form to consider your application for insurance under EPS's ContractorCover Liability programme, to determine any special policy terms, to assess a claim, etc.

We will disclose this information to EPS's insurer, TAI Underwriting Agency (Lloyds of London) who will use your information for the purposes we provided it to them (or if required by law)

For a copy of the EPS Contractors Liability Insurance Professional Indemnity policy wording click here

For a copy of the EPS Contractors Liability Insurance Public Liability and Statutory Liability policy wording click here


1. Tell us about yourself

2. Will you be providing any products or services in:

2a. The Aviation Industry that in any way impacts flight and/or navigation of any Aircraft?
2b. The Defence Industry that in any way impacts any weapon or combat systems?
2c. The Medical Industry that in any way impacts the diagnosis or treatment of any ailment, illness or disease?
2d. The Financial Services Industry that in any way provides Financial and Investment Advice?
2e. Front End Network Security?

3. Prior History

3a. Have you had any claims for professional negligence, errors or omissions in the past five (5) years?
3b. Have you had any disputes with payment of your fees in the past five (5) years?

4. Declaration

4a. After enquiry, I , the undersigned am authorised to make this Declaration
4b. Have read this Declaration and acknowledge the contents are true and complete
4c. Agree that this Declaration shall form the basis of any contract of insurance effected thereon and I undertake to inform i2i Brokers of any material alteration to these facts whether occurring before or after completion of such contract
4d. Agree that i2i Brokers may use and disclose this information in accordance with the Privacy Statement at the beginning of this Declaration