Recruitment Liability Renewal Declaration

Are you aware of any circumstances (prior or pending) that could eventuate into a claim against an employee or the company?
Are there any changes that you would like to make to your current programme?
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 and the Insurer.