i2i ContractorCover Liability Renewal Declaration

CURRENT POLICY REQUIREMENTS

Please confirm the name that the Policy should be under:

Eg. Your individual name, a partnership, sole trader or Limited Company (you do not need to list your individual name if you operate as a Limited Company)

Please confirm your typical 'job title'

e.g Software Tester, HR Consultant, Engineer, Legal (non practicing), Interim Manager, Project Manager etc . Please do not write "Director" as this is not the service that you are providing cover against and do not write "Owner or Self Employed" as this

YOUR CONTACT DETAILS

Postal Address

This is required for AML purposes

Are there any changes to your email address or cellphone number?

Yes

WHAT DO YOU NEED THIS YEAR

CONFESSION TIME

Have you ever had any disputes in your fees?

Yes

Have you ever had any claims brought against you?

Yes

ARE YOU INVOLVED IN ANY OF THE FOLLOWING:

Design or construction of products or services for medical or surgical applications?

Yes

Design or construction products or services (whether whole or in part) of aeropace, radar or navigation systems?

Yes

Development, design, manufacture, distribute or supply products or services in Network Security?

Yes

Development, design, manufacture, distribute or supply products or services that support share trading, financial transactions or calculations?

Yes

If you have ticked "yes" to any of the above, please clearly state your involvement.

AND LAST BUT NOT LEAST (AND TO KEEP THE INSURER'S HAPPY)

Is there anything else that should be brought to the attention of the Insurers (NB a material fact is one likely to influence acceptance or assessment of this questionnaire by the Underwriters. If in doubt, disclose)

I am/ We are Independent Contractors

I/We agree and accept that I/We declare and warrant that the information I/We have provided in this application is correct, truthful and complete; and that this application will form the basis of the contract between me/us and the Insurer

By ticking this box you agree you have signed your approval of the information disclosed and the use of I/We Accept is as reliable as is appropriate given the purpose for which, and in the circumstances in which a signature is required.

i2i Insurance Brokers

It's time to renew your i2i ContractorCover Liability programme

Your renewal declaration gives you the opportunity to update your details , notify us of any changes in your business activities and declare any other matters material to your insurance coverage.

CURRENT POLICY REQUIREMENTS

YOUR CONTACT DETAILS

WHAT DO YOU NEED THIS YEAR

CONFESSION TIME

ARE YOU INVOLVED IN ANY OF THE FOLLOWING:

AND LAST BUT NOT LEAST (AND TO KEEP THE INSURER'S HAPPY)

By ticking this box you agree you have signed your approval of the information disclosed and the use of I/We Accept is as reliable as is appropriate given the purpose for which, and in the circumstances in which a signature is required.

i2i Insurance Brokers

It's time to renew your i2i ContractorCover Liability programme

Your renewal declaration gives you the opportunity to update your details , notify us of any changes in your business activities and declare any other matters material to your insurance coverage.

CURRENT POLICY REQUIREMENTS

YOUR CONTACT DETAILS

WHAT DO YOU NEED THIS YEAR

CONFESSION TIME

ARE YOU INVOLVED IN ANY OF THE FOLLOWING:

AND LAST BUT NOT LEAST (AND TO KEEP THE INSURER'S HAPPY)

By ticking this box you agree you have signed your approval of the information disclosed and the use of I/We Accept is as reliable as is appropriate given the purpose for which, and in the circumstances in which a signature is required.

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