Customise Consulting's Contractor Declaration

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 Customise Consulting's Indemnity programme, to determine any special policy terms, to assess a claim, etc.

We will disclose this information to Customise Consulting's Indemnity insurer, Delta Insurance who will use your information for the purposes we provided it to them (or if required by law)

Lets get to know you

Does your role involve providing services or products in the following:

The design or construction of products or services for medical or surgical application
The design or construct products or services (whether whole or in part) of aerospace, radar or navigation systems
Development design, manufacture, distribute or supply products or services in Network Security
Development design, manufacture, distribute or supply products or services that support share trading, financial transactions or calculations

Prior history

Have you had any claims for professional negligence, errors or omissions in the past 5 years?
Please explain the nature of the claim, the date it occurred and the amount paid
Have you had any disputes with payment of your fees in the past 5 years?

Declaration