Salt Search Contractor/Temporary Worker Declaration


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

We will disclose this information to Salt Search's 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

Are you on assignment with Salt as:

Will you be providing any Products or Services involving any of the following:

Aviation Industry that in any way impact flight and/or navigation of Any Aircraft
Defence Industry that in anyway impact any weapon or combat systems
Medical Industry that in anyway impact the diagnosis or treatment of any ailment, illness or disease
Financial Services Industry that in anyway provides Financial or Investment Advice
Front end Network Security

If you have ticked "yes" in any box above, please provide a clear and concise description of what you are doing

Prior history

Have you had any claims for professional negligence, errors or omissions in the past 5 years?
Have you had any disputes with payment of your fees in the past 5 years?